脑出血术后昏迷患者气管切开后肺内感染的危险因素分析

目的 探讨脑出血术后昏迷患者气管切开后肺内感染的危险因素及预防控制对策.方法 对2010年1月—2011年1月神经外科187例脑出血术后行气管切开患者病历资料,进行回顾性调查与前瞻性监测.结果 在187例脑出血昏迷患者气管切开患者中,发生医院感染69例,其中肺内感染62例感染率为33.15％；患者年龄≥45岁,肺内感染率为42.45％,明显高于＜45岁患者的6.25％(P＜0.05);气管切开时间≥5d的肺内感染率为36.31％,高于气管切开＜5 d患者的5.26％(P＜0.05);有吸痰的患者肺内感染率为37.03％,高于无吸痰的患者的8.00％(P＜0.05);有吸烟史的患者气切后发生肺内感染率为49.18％,合并慢性阻塞性肺疾病的发生肺部感染率为58.59％,与无吸烟史及未合并慢性阻塞性肺疾病患者比较,差异有统计学意义(P＜0.05).结论 侵入性操作(吸氧、气管插管、气管切开、使用呼吸机)是引起脑出血昏迷患者器官切开后肺内感染的主要危险因素,应加强术后昏迷患者气管切开后患者肺内感染危险因素的监测及控制,有效地降低肺内感染发生率,减少脑出血术后昏迷患者的死亡率.

Risk factors for pulmonary tract infection in postoperative coma patients complicated by cerebral hemorrhage after tracheotomy

OBJECTIVE To explore the risk factors for pulmonary infection in postoperative coma patients complicated by cerebral hemorrhage after tracheotomy and the measures of prevention and control.METHODS From Jan.2010 to Jan.2011,medical records of 187 patients with intracerebral hemorrhage after tracheotomy were retrospectively reviewed and prospectively monitored.RESULTS Among 187 cases,69 cases suffered from hospital infections,62 of 69 suffered from lung infection with the infection rate of 33.15%.The pulmonary infection rate of the patients aged ≥45(42.45%) was significantly higher than that of the patients aged <45(6.25%)(P<0.05).Patients with tracheotomy time≥5 d(36.31%) were higher than those <5 d(5.26%)(P<0.05);the patients with suction(37.03%) were higher than patients without(8.00%)(P<0.05),the pulmonary infection rate of the patients with smoking history combined with COPD was 58.59%,statistically different(P<0.05)compared with the patients without smoking history.CONCLUSION Invasive operations such as inhalation,endotracheal intubation,tracheotomy and use of ventilator are the predominant risks for pulmonary infection after tracheotomy.Risk factors should be monitored and controlled to effectively reduce the incidence of pulmonary tract infection and the mortality of cerebral hemorrhage postoperative coma patients.