气囊上滞留物引流对重型颅脑损伤后肺部感染防治的影响

目的探讨气囊上滞留物引流对重型颅脑损伤后肺部感染防治的临床价值。方法对80例重症监护病房(ICU)的重型颅脑损伤需气管切开的患者,随机分为实验组和对照组,实验组选择可冲洗套管,对照组选择常规套管,实验组定期对气囊上滞留物冲洗引流,两组分别于气管切开后48h、7d、14d同步行咽试子、气囊上滞留物、下呼吸道分泌物细菌学检测。结果实验组肺部感染的发病率为22.5%,对照组肺部感染的发病率为45.0%;肺部感染患者气囊上滞留物与下呼吸道优势菌符合率为63.0%。结论气囊上滞留物病原菌的移行是导致肺部感染的重要原因之一,引流气囊上滞留物可降低重型颅脑损伤后肺部感染的发生率。

Effects of subglottic secretion drainage on pulmonary infection in severe craniocerebral injury

Objective To discuss the clinical value of subglottic secretion drainage on pulmonary infection in severe craniocerebral injuried patients. Methods Eighty severe craniocerebral injuried patients in ICU with the requirement of tracheotomy were randomized into two groups. Forty patients received aspiration of subglottic secretions as the treatment group and the other 40 patients received usual care as control. Samples were taken from pharynx mop, subglottic secretion and lower respiratory tract secretion for bacterial culture at 48 hours, 7th day and 14th day past tracheotomy. Results The incidence of pulmonary infection was 22.5% in treatment group and 45.0% in control. The same rate of predominant flora in subglottic secretion and lower respiratory tract secretion was 63.0% in patients with pulmonary infection. Conclusions Transposition of the pathologic bacteria in the subglottic secretion is one of the important causes of pulmonary infection, subglottic secretion drainage can lower the incidence of pulmonary infection in severe craniocerebral injuried patients.