颅脑损伤气管切开后医院肺部感染的临床研究

目的探讨颅脑损伤气管切开后医院肺部感染的相关因素。方法采用前瞻性和回顾性方法，对166例患者进行痰培养、药敏试验及其临床资料进行分析。结果本组医院肺部感染发生率78.9%，大多数出现在气管切开后的3～6d，病死率显著高于无医院肺部感染者(P<0.05)，普通病房的发生率显著高于ICU(P<0.01)，共培养出致病菌289株，革兰染色阴性(G-)杆菌占73.4%。结论颅脑损伤气管切开术后医院肺部感染与使用地塞米松、H2受体拮抗剂及酸泵抑制剂无关，与颅脑损伤严重程度、医院环境污染、G-杆菌感染相关；预防和治疗应立在早期1周内，应积极治疗原发病，建立ICU，监控医院环境污染，根据药敏试验联合使用抗生素控制感染。

Clinical Study of Hospital Infection of Lung in Cranial Injury Patients after Tracheotomy

OBJECTIVE To discuss the relevant factors causing hospitalinfection of lung in cranial injury patients after tracheotomy.METHODS Using prospective and retrospective studies to analyze sputum bacteria cultures,drug sensitive tests and relative clinical data of 166 cranial infury patients.RESULTS Incidence rate of hospital infection of lung was 78.9% in this group.Most occurred (3-6±0.64) days after tracheotomy.The death rate of infected patients is significantly higher than non-infected patients (P<0.05).Incidence rate of patients ingeneral ward is significantly higher than in intensive care unit (ICU) (P<0.01).Two hundred and eighty nine strains of parhogenic bacteria were found,73.4% of them were gram-negative (G ).CONCLUSIONS Hospital infection of lung in cranial injury patient after tracheotomy is not related to use of dexamethasone,H2 receptor antagonist and acid pump inhibitor,but is related to seriousness of cranial injury,environmental pollution of the hospital and infection causing by gram-negative bacteria.Prevention and control should be done within the first week after tracheotomy with active treatment of original disease and use of ICU.Also effective are controlling the environmental pollution of the hospital and select ion of antibiotics based on drug sensitive tests to control infection.