颅脑损伤昏迷患者气管切开术后并发肺部感染病原菌分析

【目的】了解颅脑损伤昏迷患者气管切开术后并发肺部感染的病原菌特点，为临床用药提供依据。【方法】收集本院收治的90例颅脑损伤昏迷患者的病例资料，分析其气管切开术后并发肺部感染的呼吸道分泌物细菌培养及药敏试验结果。【结果】送检311份痰标本，培养阳性245份，阳性率为78．8％；革兰阴性菌188株，占76．7％，革兰阳性菌39株，占15．9％，真菌18株，占7．3％；铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌为最常见的四类革兰阴性菌，对亚胺培南的敏感性较强；其中耐甲氧西林金黄色葡萄球菌（MRSA）6例，均为入院1个月后发生。【结论】颅脑损伤昏迷患者气管切开术后并发肺部感染主要以革兰阴性菌为主，痰细菌培养及药敏试验测定对临床合理使用抗生素具有重要意义。

Analysis of Pulmonary Infection Caused by Pathogens in Coma Patients with Craniocerebral Trauma af- ter Tracheotomy

Objective] To understand the characteristics of the pathogens causing pulmonary infections in coma patients with craniocerebral trauma after tracheotomy, and to provide the basis for clinical applications of antibiotics. Methods] Clinical data of 90 cases of coma patients with craniocerebral trauma were collected. The secretions from respiratory tract with pulmonary infections after tracheotomy were cultured and the drug susceptibility test was performed. Results] Of the submitted 311 cases of sputum specimens, 245 cases were cultured positive with the positive rate of 78.8 %. There were 188 strains of gram-negative bacteria accounting for 76.7%. There were 39 strains of gram-positive bacteria accounting for 15.9%. There were 18 strains of fungi accounted for 7. 3%. Pseudomonas aeruginosa, klebsiella pneumoniae, acinetobacter baummannii and Escherichia coli were the most common of four types of gram-negative bacteria which were highly sensitive to imipenem. There were 6 cases of methicillin resistance staphylococcus aureus（MRSA） which occurred one month after admission. Conclusion]Gram-negative bacteria are the main pathogens causing pulmonary infec- tions in coma patients with craniocerebral trauma after tracheotomy. The bacterial culture of secretions from respiratory tract and drug susceptibility test are very important for clinical reasonable use of antibiotics.