ICU重型颅脑损伤患者肺部感染的影响因素与抗菌药物使用情况研究  

Influencing factors for pulmonary infections in ICU patients with severe craniocerebral injury and use of antibiotics

作　　者：杜晓光[1] 董保忠 李琛[1] 张法学[1] 纪延伟[1] 张建斌[1] 殷长江[1] 

机构地区：[1]山东省交通医院神经外科,山东济南250031

出　　处：《中华医院感染学杂志》2017年第22期5145-5148,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析ICU重型颅脑损伤患者肺部感染的影响因素,并对患者抗菌药物的临床使用给予指导。方法选取医院2014年1月-2017年1月临床收治的ICU重型颅脑损伤患者261例为研究对象,统计患者感染率,分析导致患者感染的临床危险因素,检测感染患者病原菌分布并进行药物敏感度测定。结果 261例ICU重型颅脑损伤患者发生肺部感染81例,感染率为31.03%;81例颅脑外伤术后肺部感染患者共检出病原菌126株,其中革兰阴性菌88株、革兰阳性菌33株、真菌5株;革兰阴性菌对舒巴坦的敏感度高,对他唑巴坦和头孢噻肟的耐药性高,革兰阳性菌对头孢他啶的敏感度高,对头孢噻肟和左氧氟沙星的耐药性高;年龄、住院时间、昏迷情况、呼吸机应用情况、气管切开情况、合并疾病种类、休克、多发损伤是导致ICU重型颅脑损伤患者肺部感染的独立危险因素(P<0.01)。结论 ICU重型颅脑损伤患者肺部感染情况较为严重,革兰阳性菌是导致患者感染的主要致病菌,应根据药敏结果合理应用抗菌药物,并针对感染的危险因素采取针对性的干预措施。OBJECTIVE To investigate the influencing factors for pulmonary infections in ICU patients with severe craniocerebral injury and provide guidance for clinical use of antibiotics.METHODS A total of 261 ICU patients with severe craniocerebral injury who were treated in the hospital from Jan 2014 to Jan 2017 were recruited as the study objects.The infection rate was statistically analyzed,the risk factors for the infections were analyzed,the distribution of pathogens was detected,and the drug susceptibility was determined.RESULTS Of the 261 ICU pa-tients with severe craniocerebral injury,81 had pulmonary infections,with the infection rate 31.03%.Totally 126 strains of pathogens were isolated from the 81 craniocerebral injury patients with postoperative pulmonary infec-tions,of which 88 were gram-negative bacteria,33 were gram-positive bacteria,and 5 were fungi.The gram-neg-ative bacteria were highly susceptible to sulbactam but were highly resistant to tazobactam and cefotaxime;the gram-positive bacteria were highly susceptible to ceftazidime but were highly resistant to cefotaxime and levofloxa-cin.The independent risk factors for the pulmonary infections in the ICU patients with severe craniocerebral injury included the age,length of hospital stay,status of coma,use of ventilators,tracheal incision,type of complicated disease,shock and multiple injuries（P〈0.01）.CONCLUSION The status of pulmonary infection is severe in the ICU patients with severe craniocerebral injury,the gram-positive bacteria are the predominant pathogens causing the infections,and it is necessary to reasonably use antibiotics based on the result of drug susceptibility testing and take targeted intervention measures according to the risk factors for the infections.

关 键 词：重症监护 重型颅脑损伤 肺部感染 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]