61例重型颅脑损伤患者预后因素及呼吸机相关性肺炎病原学特征  

Prognostic factors and pathogens of ventilator-associated pneumonia in 61 patients with severe craniocerebral trauma

作　　者：李哲[1] 韩明锋[2] 单南冰[1] 黄继峥[3] LI Zhe;HAN Ming-feng;SHAN Nan-bing;HUANG Ji-zheng(Surgical Intensive Care Unit,NO.2 People's Hospital of Fuyang,Fuyang,Anhui236015,China;Department of Respiratory and Critical Medicine,NO.2 People's Hospital of Fuyang,Fuyang,Anhui236015,China;Department of Hospital Infection Management,NO.2 People's Hospital of Fuyang,Fuyang,Anhui236015,China)

机构地区：[1]阜阳市第二人民医院重症医学科外科病区,安徽阜阳236015 [2]阜阳市第二人民医院呼吸与危重症医学科综合病区,安徽阜阳236015 [3]阜阳市第二人民医院医院感染管理科,安徽阜阳236015

出　　处：《临床肺科杂志》2020年第12期1863-1866,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析呼吸机相关性肺炎对重型颅脑损伤患者预后影响因素,及呼吸机相关性肺炎病原学特征,为临床治疗和抗菌药物应用提供参考。方法回顾分析2018年1月1日~2019年7月31日外科ICU收治的61例重型颅脑损伤患者的临床资料,Cox比例风险回归模型分析重型颅脑损伤患者的预后因素,并分析VAP病原菌特征。结果年龄(OR=1.037,95%CI 1.006~1.069)、GCS评分(OR=0.848,95%CI 0.732~0.982)和VAP(OR=1.591,95%CI 1.237~1.843)是影响重症颅脑损伤患者的预后因素。61例重型颅脑外伤患者,VAP发生40例,发生率为65.6%;分离致病菌83株,前三位致病菌为鲍曼不动杆菌(18株)、肺炎克雷伯菌(18株)和铜绿假单胞菌(15株),构成比分别为21.7%、21.7%和18.1%。泛耐药鲍曼不动杆菌、耐碳青霉烯类肺炎克雷伯菌和耐碳青霉烯类铜绿假单胞菌分离率分别为100.0%、27.8%和53.3%。结论1)年龄、GCS评分和VAP是重型颅脑损伤患者的预后影响因素。2)重型颅脑损伤患者VAP具有感染率高、多重感染、致病菌耐药性高等特点。Objective To analyze the risks of ventilator-associated pneumonia on the prognosis of patients with severe craniocerebral trauma and the pathogenic characteristics of ventilator-associated pneumonia,so as to provide reference for clinical treatment.Methods The clinical data of 61 patients with severe craniocerebral injury were analyzed retrospectively from January 1,2018 to July 31.Cox proportional risk regression model was used to analyze the risk factors of prognosis of patients with severe craniocerebral injury and the characteristics of VAP pathogens.Results Age(OR=1.037,95%CI 1.006-1.069),GCS score(OR=0.848,95%CI 0.732-0.982)and VAP(OR=1.591,95%CI 1.237-1.843)were the risk factors for severe craniocerebral injury.The incidence of VAP was 65.6%in 40 of 61 patients with severe craniocerebral injury.83 strains of pathogenic bacteria were isolated.The top three pathogens were Acinetobacter baumannii(18 strains),Klebsiella pneumoniae(18 strains)and Pseudomonas aeruginosa(15 strains),with a composition ratio of 21.7%,21.7%and 18.1%,respectively.The isolation rates of Pan resistant Acinetobacter baumannii,carbapenem resistant Klebsiella pneumoniae and carbapenem resistant Pseudomonas aeruginosa were 100.0%,27.8%and 53.3%,respectively.Conclusion 1)Age,GCS score and VAP are the prognostic factors of patients with severe craniocerebral injury.2)VAP in patients with severe craniocerebral injury is characterized by high infection rate,multiple infections and high resistance to pathogens.

关 键 词：重型颅脑损伤 预后因素 呼吸机相关性肺炎 病原菌 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学] R446.5