重症颅脑损伤患者院内肺部感染的特点分析

目的：分析重症颅脑损伤患者院内肺炎的特点,寻找有效的临床处理对策。方法：166例重症颅脑损伤患者进行痰细菌学检查;对格拉斯哥昏迷评分（Glasgow Coma Scale,GCS）等10个候选因素进行二项Logistic回归分析。结果：致病菌以耐药肺炎克雷伯菌（23.31%）、铜绿假单胞菌（22.56%）最多见;回归分析共有6个因素进入方程：GCS、应用广谱抗菌素、气管插管/切开、机械通气、重症监护室内住院时间及病区分布,OR值分别为5.309（P=0.028）、2.518（P=0.047）、3.841（P=0.009）、2.229（P=0.049）、1.832（P=0.045）、1.070（P=0.004）。结论：耐药革兰阴性菌感染比例增高;GCS、应用广谱抗菌素、气管插管/切开、机械通气、重症监护室内住院时间及病区分布诸因素与院内肺炎的发生相关;调整抗生素的应用策略,加强消毒、隔离等管理措施将有助于减小其影响。

The Character of Nosocomial Pulmonary Infection on Severe Brain Trauma Patients

Objective：To study the character of nosocomial pneumonia on severe brain trauma patients and find an effective consultation for clinic.Methods：Bacteriologic inspection of sputum was studied on 166 patients with severe brain trauma.Ten factors including Glasrow Coma Scale（GCS）were analysed by Logistic regression analysis.Results：23.31% of all infected cases were caused by pseudomonas aeruginosa,and 22.56% by bacillus pneumoniae.Six factors were selected in the equation—GCS,applying of broad-spectrum antibiotic,endotracheal intubation/tracheotomy,mechanical ventilation,NICU hospitalization and patient distribution, the OR values were 5.309（P=0.028）,2.518（P=0.047）,3.841（P=0.009）,2.229（P=0.049）,1.832（P=0.045）and 1.070（P=0.004）respectively.Conclusions：The ratio of persister of gram-positive bacterium of nosocomial pneumonia increases in severe brain trauma patients.The incidence of infection can be affected by these six factors.It is necessary to regulate the strategy by using antibiotic and reinforce the sterilization and isolation of NICU.