重型颅脑损伤患者气管切开后呼吸道菌群变化特点及肺部感染的影响因素  

Changes of respiratory tract flora and influencing factors of lung infection in patients with severe craniocerebral injury after tracheotomy

作　　者：陈东 CHEN Dong(Department of Neurosurgery,the Second People's Hospital of Yangzhou,Jiangsu Province,Yangzhou225006,China)

机构地区：[1]江苏省扬州市第二人民医院神经外科,江苏扬州225006

出　　处：《中国当代医药》2023年第35期84-88,共5页China Modern Medicine

摘　　要：目的探究重型颅脑损伤患者气管切开后呼吸道菌群变化特点及肺部感染的影响因素。方法选取2019年1月至2022年12月江苏省扬州市第二人民医院收治的68例重型颅脑损伤且行气管切开后患者作为研究对象,采集所有患者不同时间段的痰液进行培养评估呼吸道菌群变化情况;根据患者是否感染肺部疾病分为肺部感染组(n=48)和肺部未感染组(n=20),收集患者详细的临床基础资料,并进行logistic回归分析感染的因素。结果气管切开患者肺部感染发生率高,肺部感染48例,占70.59%。随着时间的变化,呼吸道菌群也产生了变化,其中第1天肺炎克雷伯菌和鲍曼不动杆菌占据前2位,占比分别为43%和14%;第4天肺炎克雷伯菌和黏质沙雷菌占据前2位,占比分别为41%和14%;第7天洋葱伯克霍尔德菌和肺炎克雷伯菌占据前2位,占比分别为27%和24%;第10天洋葱伯克霍尔德菌和肺炎克雷伯菌仍占据前2位,占比分别为26%和23%;第14天洋葱伯克霍尔德菌和肺炎克雷伯菌仍占据前2位,占比分别为28%和25%;肺炎克雷伯菌第1、4、7、14天的多重耐药菌占比越来越高;鲍曼不动杆菌和洋葱伯克霍尔德菌第1、4、7、10天的多重耐药菌占比越来越高;金黄色葡萄球菌第1、4、7天的多重耐药菌占比越来越高;肺部感染组患者年龄、昏迷持续时间≥2周、脑梗死、严重低蛋白血症及机械通气时间≥2周的占比均高于肺部未感染组,肺部感染组患者早期营养支持、留置空肠管占比低于肺部未感染组,差异有统计学意义(P<0.05);通过多因素logistic回归分析发现,肺部感染组患者年龄(β=0.354,OR=1.456,95%CI=1.164~1.799)、昏迷持续时间≥2周(β=0.622,OR=1.865,95%CI=1.233~2.798)、脑梗死(β=1.513,OR=2.463,95%CI=0.608~5.284)、严重低蛋白血症(β=1.639,OR=3.417,95%CI=1.908~8.284)是导致重型颅脑损伤患者气管切开后呼吸道菌群变化肺部感染的主要危险因素;而早期营养支�Objective To explore the characteristics of respiratory tract flora and the influencing factors of pulmonary infection in patients with severe craniocerebral injury after tracheotomy.Methods A total of 68 patients with severe craniocerebral injury who underwent tracheotomy from January 2019 to December 2022 in the Second People's Hospital of Yangzhou were selected as subjects.Sputum of all patients at different time periods was collected and cultured to evaluate the changes of respiratory microflora.Patients were divided into pulmonary infection group(n=48)and non-pulmonary infection group(n=20)according to whether they were infected with lung disease.Detailed basic clinical data of patients were collected,and the factors of infection were analyzed by logistic regression.Results The incidence of pulmonary infection was high in patients with tracheotomy,48 cases(70.59%)were infected.With the change of time,the respiratory tract flora also changed,among which Klebsiella pneumoniae and Acinetobacter baumannii accounted for 43%and 14%on day 1,respectively.On day 4,Klebsiella pneumoniae and Serratia marcescens occupied the first two places,accounting for 41%and 14%,respectively.On day 7,Burkholderia cepacia and Klebsiella pneumoniae occupied the first two places,accounting for 27%and 24%,respectively.On day 10,Burkholderia cepacia and Klebsiella pneumoniae still occupied the first two places,accounting for 26%and 23%,respectively.On day 14,Burkholderia cepacia and Klebsiella pneumoniae still occupied the first two places,accounting for 28%and 25%respectively.The proportion of multidrug-resistant bacteria in Klebsiella pneumoniae at day 1,4,7 and 14 was increasing.The proportion of multidrug-resistant bacteria in Acinetobacter baumannii and Burkholderia cepacia at the 1st,4th,7th and 10th day was increasing.The proportion of multi-drug-resistant bacteria in the 1st,4th and 7th days of Staphylococcus aureus was increasing.The percentages of age,coma duration≥2 weeks,cerebral infarction,severe hypoproteinemia and mecha

关 键 词：重型颅脑损伤 气管切开 呼吸道 菌群变化 影响因素 痰液 

分 类 号：R619.3[医药卫生—外科学]