高压氧科气管切开患者感染的病原学分析及护理对策

目的分析高压氧科气管切开患者感染的病原学特点及药敏情况,采取科学的护理方法。方法首都医科大学附属北京朝阳医院高压氧科2011年5月-2013年2月共收治气管切开患者427例,所有患者均取痰液进行病原菌培养,对院内肺炎感染情况、易感因素及护理对策进行分析。结果共出现肺部感染113例,感染发生率为26.46%。其中,ICU转入316例,感染104例,感染发生率为32.91%。113例感染患者痰培养结果显示,以革兰阴性（G-）菌为主要感染病原菌,共71株,占62.84%,其次为革兰阳性（G＋）菌与真菌,分别为33株与9株,占29.20%、7.96%。G-菌感染前5位的排列顺位依次是铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌及洋葱伯克霍尔德菌。G＋菌感染主要是金黄色葡萄球菌、表皮葡萄球菌。真菌感染以白色念珠菌为主。G-菌对青霉素、左氧氟沙星敏感性较低,普遍耐药,对亚胺培南、万古霉素敏感性较高,但鲍曼不动杆菌对以上两种抗生素敏感性仅为50%。G＋菌对亚胺培南、万古霉素、头孢哌酮/舒巴坦钠敏感性较高。结论气管切开患者容易出现肺部感染,应加强气道的护理,阻断病原菌的侵入,同时对气管切开患者进行定期痰培养,可在感染早期及时发现,给予敏感抗生素治疗,降低死亡率。

Etiology analysis of infection patients with tracheotomy in Department of Hyperbaric Oxygen and its nursing countermeasures

Objective To analyze the etiology characteristics and drug susceptibility of infection patients with tra cheotomy in Department of Hyperbaric Oxygen,adopt scientific nursing methods.Methods 427 cases of patients treated with tracheotomy in Department of Hyperbaric Oxygen,Beijing Chaoyang Hospital Affiliated to Capital Medical U niversity from May 2011 to February 2013 were selected.All patients were given pathogenic bacteria culture.Then in fection status and risk factors of nosocomial pneumonia and nursing countermeasures were analyzed.Results There were 113 cases pulmonary infection,infection rate was 26.46%.316 cases transferred from ICU,104 cases had infec tion,the incidence of infection was 32.91%.Sputum culture results of 113 cases of infection patients showed that the G-bacteria was the main pathogens of infection,had a total of 71 strains,accounting for 62.84%,followed by G＋ bacteria and fungi,33 strains and 9 strains respectively,accounting for 29.20%,7.96%.The top 5 bacteria of G-bacteria infection were Pseudomonas aeruginosa,Klebsiella pneumoniae and E.coli,Acinetobacter baumannii,Enterobacter cloacae and Onion burkholderia bacteria.Staphylococcus aureus and Epidermis staphylococcus were the mainly bacte ria of G＋ bacteria infection.Fungus infection was given priority to candida albicans.G-bacteria had low susceptibility to Penicillin,Levofloxacin,had general drug resistance,which had high susceptibility to Impenem,Vancomycin,but the susceptibility of Acinetobacter baumannii to the above two kinds of antibiotic sensitivity was only 50%.G＋ had high susceptibility to Impenem,Vancomycin,and Cefoperazone Sodium/ Sulbactam Sodium.Conclusion Patients with tracheotomy are easy to get lung infection,airway nursing should be strengthened,block the invasion of the pathogen.At the same time,sputum culture should be taken in patients with tracheotomy,found patients in the early infections,given the sensitive antibiotic treatment,in order to reduce the mortality.