N-乙酰半胱氨酸联合经鼻或经口气道插管方式在重度颅脑外伤急救中的应用  

Application of N-acetylcysteine combined with nasal or oral airway intubation in emergency treatment of severe craniocerebral trauma and analysis of risk factors of pulmonary infection after intubation

作　　者：孙冕 邓明尧 林晓伟 袁金堂 Sun Mian;Deng Mingyao;Lin Xiaowei(Emergency Department,Sanya People's Hospital,Sanya 572000,China)

机构地区：[1]三亚市人民医院急诊科,572000

出　　处：《中华保健医学杂志》2021年第3期273-275,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的观察N-乙酰半胱氨酸(NAC)对不同气道插管方式在重度颅脑外伤急救中的应用及插管后肺部感染的危险因素。方法选取三亚市人民医院2014年1月~2019年3月收治的重症颅脑损伤患者102例,其中经鼻气管插管为观察组,经口气管插管患者为对照组,每组患者51例,比较两组患者呼吸性相关肺炎发生率、下气道分泌物细菌、导管生物被膜分布之间的差异,分析插管后肺部感染的危险因素。结果通过对患者机械通气48 h后的评估,3~5 d观察组患者的呼吸机相关性肺炎(VAP)发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组患者收集痰液131例,对照组患者收集痰液152例,患者发生鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、肺炎链球菌、化脓性链球菌感染情况之间的差异无统计学意义(P>0.05);两组患者的气管导管生物被膜之间的差异无统计学意义(P>0.05);患者的年龄、机械通气时间、抗菌药使用情况、胃内容物吸入情况、气管切开情况、插管方式之间的差异有统计学意义(P<0.05)。结论在重度颅脑外伤急救中,NAC联合经鼻气管插管的感染风险较低。年龄、机械通气时间、抗菌药使用情况、胃内容物吸入情况、气管切开情况均为肺部感染危险因素。Objective To observe the application of N-acetylcystein in emergency treatment of severe craniocerebral trauma with different airway intubation methods and the risk factors of pulmonary infection after intubation.Methods 102 patients with severe craniocerebral injury admitted to our hospital from January 2014 to March 2019 were selected as the research objects.Among them,nasotracheal intubation was the observation group and orotracheal intubation was the control group.There were 51 patients in each group.The incidence of respiratory-related pneumonia,the distribution of bacteria in lower airway secretions and biofilm of catheter were compared between the two groups,and the pulmonary infection after intubation was analyzed.Risk factors.Results After 48 hours of mechanical ventilation,the incidence of VAP in the observation group was significantly lower than that in the control group(P<0.05).A total of 131 sputum samples were collected in the observation group and 152 sputum samples were collected in the control group.Acinetobacter baumannii and Pseudomonas aeruginosa were found in the patients.There was no significant difference in the infection of Klebsiella pneumoniae,Staphylococcus aureus,Streptococcus pneumoniae and Streptococcus pyogenes;there was no significant difference in the biofilm of tracheal duct between the two groups(P>0.05);the age of patients,the duration of mechanical ventilation,the use of antibiotics,the inhalation of gastric contents,tracheotomy,and so on.The difference of intubation methods was statistically significant(P<0.05).Conclusion In the emergency treatment of severe craniocerebral injury,the risk of infection of N-acetylcystein combined with nasotracheal intubation is lower.At the same time,through the analysis of the risk factors of pulmonary infection after intubation,the age of the patients,the time of mechanical ventilation,the use of antibiotics,the inhalation of gastric contents and the tracheotomy were all risk factors.

关 键 词：重型颅脑损伤 机械通气 呼吸相关肺炎 气管插管 

分 类 号：R651[医药卫生—外科学]