重型颅脑损伤并发肺部感染79例临床研究

目的探讨重型颅脑损伤患者并发肺部感染的临床特点及防治措施。方法分析79例重型颅脑损伤患者并发肺部感染的相关危险因素,痰培养及药敏试验结果,抗生素的应用等临床资料。结果重型颅脑损伤并发肺部感染的危险因素有年龄和基础疾病、误吸、留置胃管、吸痰、气管插管和气管切开、抑酸药物的应用、机械通气以及较长时间应用广谱抗生素。本组79例患者痰培养出致病菌11种共103株,其中革兰阴性菌74株,占71.8%,对亚胺培菌及头孢他定较敏感,革兰阳性菌25株,占24.3%,对万古霉素敏感,真菌4株,占3.9%。经抗感染治疗,肺部感染痊愈36例,控制19例,因肺部感染导致死亡24例。结论重型颅脑损伤并发肺部感染的原因多见。病原菌以革兰阴性菌为主,根据药敏试验结果合理应用抗生素,加强气道管理及营养支持,稳定内环境等对防治肺部感染有重要意义。

Clinical study of 79 patients with severe craniocerebral injury complicated with pulmonary infection

Objective To investigate the clinical characteristics and prevention measures of patients with severe craniocerebral in- jury patients complicated with pulmonary infection. Methods The clinical data of 79 patients with severe craniocerebral injury complicat- ed with pulmonary infection was retrospectively analyzed, such as the associated risk factors, sputum culture and drug sensitive test re- suits, the application of antibiotics and so on. Results The risk factors included age, basic diseases, aspiration, indwelling gastric tube, suction, intubation and tracheotomy, the use of acid suppressive drugs, mechanical ventilation and long time use of broad-spectrum antibi- otics. There were 11 kinds and 103 strains of bacteria isolated from sputum culture. The gram negative bacteria, which were sensitive to imipenem and ceftazidime, were 74 strains, accounting for 71.8%. 25 strains of gram-positive bacteria sensitive to vancomycin, and 4 strains of fungus accounting for 3.9%. After the antibiotic therapy, 36 cases of pulmonary infection were cured, 19 cases controlled, and 24 deaths reported. Conclusion The causes of severe craniocerebral injury complicated with pulmonary infection are various, and its pathogenic bacteria mostly are gram negative bacteria. The use of antibiotics should be according to the results of drug sensitive test, the airway management and nutritional support should be strengthened, and the internal environment should be kept stable.