ICU重型颅脑损伤患者肺部感染的影响因素与抗菌药物使用情况研究

发布时间：2018-11-25 16:49

【摘要】：目的分析ICU重型颅脑损伤患者肺部感染的影响因素,并对患者抗菌药物的临床使用给予指导。方法选取医院2014年1月-2017年1月临床收治的ICU重型颅脑损伤患者261例为研究对象,统计患者感染率,分析导致患者感染的临床危险因素,检测感染患者病原菌分布并进行药物敏感度测定。结果 261例ICU重型颅脑损伤患者发生肺部感染81例,感染率为31.03%;81例颅脑外伤术后肺部感染患者共检出病原菌126株,其中革兰阴性菌88株、革兰阳性菌33株、真菌5株;革兰阴性菌对舒巴坦的敏感度高,对他唑巴坦和头孢噻肟的耐药性高,革兰阳性菌对头孢他啶的敏感度高,对头孢噻肟和左氧氟沙星的耐药性高;年龄、住院时间、昏迷情况、呼吸机应用情况、气管切开情况、合并疾病种类、休克、多发损伤是导致ICU重型颅脑损伤患者肺部感染的独立危险因素(P0.01)。结论 ICU重型颅脑损伤患者肺部感染情况较为严重,革兰阳性菌是导致患者感染的主要致病菌,应根据药敏结果合理应用抗菌药物,并针对感染的危险因素采取针对性的干预措施。
[Abstract]:Objective to analyze the influencing factors of pulmonary infection in patients with severe craniocerebral injury (ICU) and to provide guidance for the clinical use of antimicrobial agents. Methods from January 2014 to January 2017, 261 patients with severe craniocerebral injury of ICU were selected as study subjects. The infection rate of patients was counted and the clinical risk factors of infection were analyzed. The distribution of pathogenic bacteria in infected patients was detected and drug sensitivity was measured. Results there were 81 cases of pulmonary infection in 261 patients with severe craniocerebral injury of ICU. The infection rate was 31.03%. A total of 126 strains of pathogenic bacteria were detected in 81 cases of postoperative pulmonary infection after craniocerebral trauma, including 88 strains of Gram-negative bacteria, 33 strains of Gram-positive bacteria and 5 strains of fungi. Gram-negative bacteria were highly sensitive to sulbactam, highly resistant to tazobactam and cefotaxime, highly sensitive to ceftazidime, and highly resistant to cefotaxime and levofloxacin. Age, length of stay, coma, ventilator use, tracheotomy, complicated diseases, shock and multiple injuries were independent risk factors for pulmonary infection in patients with ICU severe craniocerebral injury (P0.01). Conclusion the pulmonary infection in ICU patients with severe craniocerebral injury is serious. Gram-positive bacteria are the main pathogens leading to the patients' infection. The antibiotics should be used reasonably according to the results of drug sensitivity. And targeted intervention measures were taken in view of the risk factors of infection.
【作者单位】：山东省交通医院神经外科;
【分类号】：R563.1;R651.15

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