重型颅脑损伤患者气管切开术后下呼吸道感染的防治

目的调查重型颅脑损伤患者气管切开术后下呼吸道感染状况及探讨其防治对策.方法对我科2000年1月-2005年8月重型颅脑损伤行气管切开的患者进行回顾分析.结果198例重型颅脑损伤行气管切开患者均出现下呼吸道感染,其中154例行细菌培养(77.8%),培养出致病菌194株,40例有双重感染(26.0%);革兰阴性杆菌126株占65.0%,革兰阳性球菌54株占27.8%,真菌14株占7.2%,这些菌株对临床常用抗菌药物都有不同程度的耐药性.198例下呼吸道感染经治疗感染控制者160例,总有效率为80.8%.结论重型颅脑损伤患者气管切开术后下呼吸道感染发生率高,危险因素众多,较难控制,要采取有效措施控制医院感染的发生.

Prevention and treatment of lower respiratory tract infection in patients with severe brain injury after tracheotomy

Objective To investigate the state of lower respiratory tract infection in patients with severe brain injury after tracheotomy and study its prevention and treatment.Methods To retrospectively study the patients with severe brain injury after tracheotomy at our unit in our hospital from Jun 2000 to Aug 2005.Results The infection rate of lower respiratory in 198 patients was 100%.Bacteria culture of airway secretion and drug sensitive test were used to analyze etiology in 154 patients(77.8%).Among 154 patients,we isolated 194 strains of pathogens and 40 patients had double pathogens(26.0%).65.0% of 194 strains of pathogens were Gram-negative bacteria,27.8% Gram-positive,and 7.2% fungi.These pathogens resisted some antibiotics used usually at diffferent degrees.The effective rate of the control of infection of lower respiratory in 198 patients with severe brain injury after tracheotomy was 80.8%.Conclusion The infection rate of lower respiratory in the patients with severe brain injury after tracheotomy is very high,can be caused by many dangerous factors,is not controlled easily,so we must take effective measures to carefully control and prevent the infection.