颅脑外伤患者术后肺部感染危险因素及病原菌药敏情况研究  

Risk factors for postoperative pulmonary infections in patients with craniocerebral trauma and drug susceptibility of pathogens

作　　者：毛瑞 董乐[1] 杨美娟[1] 从立明 王小华[1] 

机构地区：[1]天津市环湖医院颅脑损伤二病区,天津300000

出　　处：《中华医院感染学杂志》2017年第6期1289-1292,共4页Chinese Journal of Nosocomiology

基　　金：青年科学家基金资助项目(81500936)

摘　　要：目的调查颅脑外伤患者术后肺部感染危险因素及病原菌药敏性,为临床治疗提供指导。方法选取医院2015年1月-2016年1月收治的颅脑外伤患者168例,针对患者的肺部感染情况进行调查,对患者的临床资料进行回顾性分析,并对感染病原菌及耐药性进行检测。结果 168例颅脑外伤患者中,术后肺部感染63例,感染率为37.50%;经对患者相关临床资料进行对比分析后发现,年龄、合并疾病种类、抗菌药物应用、昏迷情况、呼吸机应用、气管切开、住院时间、受伤方式均是颅脑外伤患者发生术后肺部感染的影响因素,且差异有统计学意义(P<0.05);63例颅脑外伤术后肺部感染患者共检出病原菌88株,以革兰阴性菌为主,共检出66株占75.00%;检出的革兰阴性菌对亚胺培南的耐药率为0,对氨苄西林和哌拉西林的耐药性率为100.00%;革兰阳性菌对环丙沙星的耐药率为0,对克拉维酸、红霉素的耐药率为100.00%。结论年龄、昏迷情况、呼吸机应用、气管切开情况和住院时间是导致患者术后肺部感染的独立危险因素,临床应结合患者的自身情况、病原菌培养结果以及药敏试验结果,给予针对性的治疗措施。OBJECTIVE To investigate the risk factors for postoperative pulmonary infections in patients with craniocerebral trauma and analyze the drug susceptibility of pathogens so as to provide guidance for clinical treatment.METHODS A total of 168 patients with craniocerebral trauma who were treated in the hospital from Jan 2015 to Jan 2016 were enrolled in the study,then the prevalence of pulmonary infection was investigated,the clinical data of the patients were retrospectively analyzed,and the distribution and drug resistance of the pathogens causing the infection were detected.RESULTS Of the 168 patients with craniocerebral trauma,63 had postoperative pulmonary infection,with the infection rate 37.50%.The comparative analysis of the related clinical data of the patients showed that the influencing factors for the postoperative pulmonary infection in the patients with craniocerebral trauma included the ages,types of complicated disease,use of antibiotics,coma,use of ventilator,tracheotomy,length of hospital stay,and injury mode（P〈0.05）.Totally 88 strains of pathogens were isolated from 63 craniocerebral trauma patients with postoperative pulmonary infection,of which 75.00%（66strains）were gramnegative bacteria.The drug resistance rate of the isolated gram-negative bacteria to imipenem was 0%,and the drug resistance rate to ampicillin and piperacillin was 100.00%.The drug resistance rate of gram-positive bacteria to ciprofloxacin was 0%,and the drug resistance rate to clavulanic acid and erythromycin was 100.00%.CONCLUSIONThe independent risk factors for the postoperative pulmonary infections in the patients include the age,coma,use of ventilator,tracheotomy,and length of hospital stay.It is necessary for the hospital to take targeted treatment measures based on the patients＇ condition and result of culture of pathogens,as well as result of drug susceptibility testing.

关 键 词：颅脑外伤 肺部感染 危险因素 病原菌 

分 类 号：R563.1[医药卫生—呼吸系统]