摘要
目的探讨神经外科气管切开术后下呼吸道感染特点及其危险因素。方法选取2015年1月至2017年12月长江航运总医院神经外科收治的239例行气管切开术治疗的重度颅脑损伤患者,男140例,女99例,年龄(55±3)岁,年龄范围为18~84岁。观察患者下呼吸道感染的发生率、病原菌分布情况,统计患者的一般资料与下呼吸道感染的相关性。结果患者下呼吸道感染率为37.7%(90/239),共检出病原菌186株,以革兰氏阴性菌感染为主,未分离出真菌感染菌株。单因素分析显示年龄、昏迷时间、气管切开时间、慢性呼吸系统疾病史、糖尿病史、合并伤、激素应用情况、抗生素应用种类、抗生素应用时间、雾化吸入情况、血清白蛋白是影响下呼吸感染的因素,差异有统计学意义(P<0.05)。多因素logistic分析显示糖尿病史、昏迷时间≥7 d、气管切开时间≥7 d是气管切开术后下呼吸道感染的独立危险因素,差异有统计学意义(P<0.05),血清白蛋白≥30 g/L是气管切开术后下呼吸道感染的保护性因素,差异有统计学意义(P<0.05)。结论重型颅脑损伤患者气管切开术后下呼吸道感染是多因素综合作用的结果,病原菌以革兰氏阴性菌为主,应采用集束化措施以减少下呼吸道感染的发生。
Objective To investigate the characteristics and risk factors of low respiratory tract infection after tracheotomy in neurosurgery.Methods A retrospective study was performed on 239 cases of patients with severe craniocerebral injury who were admitted in the department of Neurosurgery,General Hospital of The Yangtze River Shipping from January 2015 to December 2017.There were 140 males and 99 females,aged(55±3)years old,ranging in age from 18 to 84 years old.The incidence of lower respiratory tract infection and the distribution of pathogenic bacteria were observed,and the correlation between the general information of patients and lower respiratory tract infection was calculated.Results The infection rate of lower respiratory tract was 37.7%(90/239),186 cases of pathogenic bacteria were detected,mainly gram-negative bacteria infection,and no fungal infection strain was isolated.Univariate analysis showed that age,duration of coma,duration of tracheotomy,history of chronic respiratory disease,history of diabetes,combined injury,hormone use,type of antibiotic use,duration of antibiotic use,aerosol inhalation,and serum albumin were the factors affecting respiratory infection,and the differences were statistically significant(P<0.05).Multivariate logistic analysis showed that history of diabetes,duration of coma≥7 days,and duration of tracheotomy≥7 days were independent risk factors for lower respiratory tract infection after tracheotomy the difference was statistically significant(P<0.05),serum albumin≥30 g/L was a protective factor for lower respiratory tract infection after tracheotomy the difference was statistically significant(P<0.05).Conclusion Lower respiratory tract infection after tracheotomy in patients with severe craniocerebral injury is the result of a combination of multiple factors.Gram-negative bacteria are the main pathogens.Clustering measures should be taken to reduce the occurrence of lower respiratory tract infection.
作者
牛香群
魏梦妮
黄云
刘敏
Niu Xiangqun;Wei Mengni;Huang Yun;Liu Min(Department of Hospital Infection Management,General Hospital of the Yangtze River Shipping,Wuhan 430010,China;Department of Neurosurgery,General Hospital of the Yangtze River Shipping,Wuhan 430010,China;Department of the Outpatient,General Hospital of the Yangtze River Shipping,Wuhan 430010,China)
出处
《中国临床实用医学》
2020年第5期36-39,共4页
China Clinical Practical Medicine
关键词
神经外科
重型颅脑损伤
气管切开
下呼吸道感染
危险因素
病原菌
Neurosurgery
Severe craniocerebral injury
Tracheotomy
Lower respiratory tract infection
Risk factors
Pathogenic bacteria
