颅脑损伤患者气管切开术后医院感染危险因素分析

目的了解颅脑损伤患者气管切开术后下呼吸道感染特点和危险因素,以便采取有效预防与控制措施。方法对住院颅脑损伤全气管切开术后40例患者进行调查分析,对病原学标本进行细菌培养和药敏试验,调查下呼吸道感染情况,分析其相关危险因素。结果 40例患者中发生医院感染29例次,医院感染例次率为72.5%,以下呼吸道感染占首位(例次感染率82.75%),病原菌以革兰阴性菌为主,共35株,占76.1%,其次革兰阳性球菌6株,占13.0%,真菌5株,占10.9%;调查患者均有严重的基础疾病及行气管插管、气管切开、吸痰等治疗,气管切开置管时间越长、住院天数越多、下呼吸道感染率越高,与不合理使用抗菌药物密切相关。结论气管插管、气管切开、气管切开置管时间长、住院天数多、抗菌药物使用不合理等是下呼吸道感染发生的危险因素;加强无菌技术操作,提高患者自身免疫力,缩短置管时间及住院天数,合理应用抗菌药物,可降低医院感染发病率。

Nosocomial Infection after Tracheotomy among Craniocerebral Injury Patients:Investigation and Analysis of Risk Factors and Preventive Measures

OBJECTIVE To understand the features of lower respiratory tract infection among craniocerebral injury Datients after tracheotomy and risk factors in order to take effective preventive and control measures.METHODS Forty cases with craniocerebral injury patients after tracheotomy were investigated by bacterial culturing and drug susceptibility test to investigate the lower respiratory tract infections and analyze the related risk factors.RESULTS From them 29 case-times were with nosocomial infection,the cases times nosocomial infection rate was 72.5％ and the lower respiratory tract infection occupied the first place (82.75％),the pathogens were mainly Gram.negative bacteria (35 strains,76.1％),then six Gram-positive cocci (6 strains,13.0％) and fungi (5 strains,10.9％).This group of patients had severe underlying diseases,and the longer the tube indwelling time and intubation,hospitalization days were,the higher the lower respiratory tract infection rates.The irrational use of antimicrobial drugs was also closely related.CONCLUSIONS Endotracheal intubation,tracheotomy,a long time of trachemomy tube indwelling and hospital days and irrational use of antimicrobial agents are the risk factors for lower respiratory tract infection.Enhancing the aseptic techniques,improveing the patient's own immune system,shortening the catheterization time and hospitalization days,and rationally using the antimicrobial drugs can reduce the incidence of nosoeomial infection.