重型颅脑损伤患者气管切开后菌群变迁的相关研究  

Changes of bacterial flora in patients with severe traumatic brain injury after tracheotomy

作　　者：颜羽 朱坤灿[2] 沈和平[2] 王耿焕[2] 褚正民[2] 沈建国[2] YAN Yu;ZHU Kuncan;SHEN Heping(The Second Affiliated Hospital of Jiaxing University,Zhejiang 314000,China)

机构地区：[1]浙江中医药大学,杭州310053 [2]浙江嘉兴学院附属第二医院

出　　处：《浙江创伤外科》2022年第6期1016-1019,共4页Zhejiang Journal of Traumatic Surgery

基　　金：嘉兴市科技计划(2018AD32004,2019AD32138);浙江省医药卫生科技计划(2022KY1257)。

摘　　要：目的探索重型颅脑损伤患者气管切开后不同时间段呼吸道的菌群变迁,分析肺部感染的相关因素。方法选择嘉兴学院附属第二医院2018年7月至2020年7收治的(符合纳入标准的)重型颅脑损伤患者157例,采集入组患者气管切开第1、4、7、10、14天的痰液进行培养,观察呼吸道菌群的变迁,同时收集患者的临床资料,包括性别、年龄、高血压、糖尿病、入院格拉斯哥评分(GCS)、昏迷持续时间、早期营养支持、留置空肠管、质子泵抑制剂、激素、癫痫、颅内感染、脑梗塞、严重低蛋白血症、机械通气时间、肝肾功能等情况,采用Logistic回归分析肺部感染的相关因素。结果共纳入重型颅脑损伤气管切开患者157例,其中肺部感染126例,检出的前8位菌群在气管切开7天出现菌群变迁,气管切开第10天、14天与第7天时的菌群相似。耐药菌的变化也出现在气管切开第7天。经多因素Logistic回归分析显示,二组患者年龄,入院GCS评分、昏迷时间≥2周、早期营养支持、留置空肠管、严重低蛋白血症有统计学差异(P>0.05)。结论重型颅脑损伤气管切开患者肺部感染率高,气管切开7天时菌群出现变迁。老龄、GCS评分低、昏迷时间长、严重低蛋白血症是肺部感染的危险因素,而早期营养支持、留置空肠管是肺部感染的保护因素。Objective To explore the changes of respiratory tract bacterial flora in patients with severe craniocerebral injury at different periods after tracheotomy,and analyze the related factors of pulmonary infection.Methods A total of 157 patients with severe craniocerebral injury admitted to the our hospital from July 2018 to July 2020 were selected.Sputa collected from the patients at 1,4,7,10 and 14 days of tracheotomy were cultured to observe the changes of respiratory microflora.Clinical data were collected,including gender,age,hypertension,diabetes,Glasgow admission score(GCS),coma duration,early nutritional support,jejunal nutrient canal,proton pump inhibitors,hormones,epilepsy,intracranial infection,cerebral infarction,severe hypoproteinemia,mechanical ventilation duration,liver and kidney function.Logistic regression analysis was used to analyze the related factors of pulmonary infection.Results A total of 157 patients with severe craniocerebral injury undergoing tracheotomy were included,including 126 patients with pulmonary infection.The first 8 microflora detected showed a change of microflora at 7 days after tracheotomy,and the bacteria at 10 days and 14 days after tracheotomy were similar to those at 7 days.The change of drug-resistant bacteria also occurred at 7 days after tracheotomy.Multivariate logistic regression analysis showed that there were significant differences between the two groups in age,admission GCS score,coma time≥2 weeks,early nutritional support,jejunal nutrient canal,and severe hypoproteinemia(P<0.05).Conclusion The incidence of pulmonary infection in patients with severe craniocerebral injury undergoing tracheotomy is high.The flora changed on the 7th day after tracheotomy.Old age,low GCS score,long coma time and severe hypoalbuminemia are risk factors of pulmonary infection,while early nutritional support and indwelling jejunum tube are protective factors of pulmonary infection.

关 键 词：颅脑损伤 肺部感染 危险因素 气管切开 菌群分布 

分 类 号：R651.1[医药卫生—外科学]