烧伤科成人院内获得性肺炎危险因素的研究

目的了解烧伤科成人院内获得性肺炎的危险因素,为临床治疗提供参考资料。方法对2001年1月～2010年12月于本院烧伤科患者中诊断为院内获得性肺炎者运用统计学方法进行回顾性分析。结果老年患者比年轻患者院内获得性肺炎感染率高,差异有统计学意义(χ2=28.3,P<0.05);重度及特重烧伤患者较轻中度烧伤患者院内获得性肺炎感染率高,差异有统计学意义(χ2=123.1,P<0.05);有吸入性损伤者较无吸入性损伤者院内获得性肺炎感染率高,差异有统计学意义(χ2=116.6,P<0.05);气管切开及机械通气者较未行气管切开者院内获得性肺炎感染率高,差异有统计学意义(χ2=51.2,P<0.05);女性较男性院内获得性肺炎感染率低,但差异无统计学意义(χ2=0.43,P>0.05)。痰培养显示,院内获得性肺炎主要有2种或2种以上细菌混合感染引起,革兰阴性杆菌是主要的致病菌。创面细菌迁移和胃肠-肺感染途径是院内获得性肺炎的重要感染途径。结论烧伤科感染院内获得性肺炎危险因素有年龄、烧伤程度、吸入性损伤、气管切开,与性别无关。对胃肠道反流和创面处理上需要引起足够的重视,并尽量避免交叉感染。

Study on the risk factors of hospital-acquired pneumonia in burn unite

Objective To study the risk factors of hospital-acquired pneumonia(HAP)in burn unite,to provide reference data for clinical treatment.Methods Patients with HAP collected from January 2001 to December 2010 were retrospectively analyzed.Results The HAP infection rate in elderly patients,severe and severe burn patients,inhalation injury patients,tracheotomy and mechanical ventilation patients,was higher than that in younger patients,mild to moderate burn patients,non-inhalation injury patients,no tracheotomy patients,respectively,the difference was statistically significant(χ2=28.3,123.1,116.6,51.2,respectively,P<0.05);The HAP infection rate in female patients was lower than that in male patients,but the difference was not statistically significant(χ2=0.43,P>0.05).Sputum culture showed hospital-acquired pneumonia caused by mixed infection of two kinds or more than two kinds of bacteria,gram-negative bacilli was the major pathogen.The wound bacterial migration and gastrointestinal-pulmonary route of infection was an important route of infection of hospital acquired pneumonia.Conclusion The burn unit infections hospital-acquired pneumonia risk factors are age,burn degree of inhalation injury,tracheotomy,independent of gender.It need to attract enough attention for gastrointestinal reflux and wound treatment,and to avoid cross-infection.