颅脑创伤患者气管切开术后下呼吸道感染的临床研究

发布时间：2018-05-27 07:32

本文选题：颅脑创伤 + 气管切开术　；参考：《中华医院感染学杂志》2016年04期

【摘要】：目的监测颅脑创伤患者气管切开术后下呼吸道感染率,分析病原菌分布,为临床治疗提供参考依据。方法选取2013年12月-2015年3月医院收治的颅脑创伤患者86例,所有患者行气管切开术,术后取痰液标本进行病原菌培养,监测下呼吸道感染率,并分析病原菌分布及耐药性。结果 86例颅脑创伤患者发生下呼吸道感染59例,感染率为68.6%;共检出病原菌72株,其中革兰阴性菌52株占73.2%,革兰阳性菌13株占18.1%,真菌7株占9.7%;革兰阴性菌中以铜绿假单胞菌、肺炎克雷伯菌及鲍氏不动杆菌为主,分别16.7%、18.1%、23.6%,革兰阳性菌以金黄色葡萄球菌为主,占6.9%,真菌以白色假丝酵母菌为主占6.9%;主要革兰阴性菌对头孢曲松、环丙沙星及美洛西林均表现出了较高的耐药性,耐药率50.0%,对亚胺培南的耐药率较低15.0%,主要革兰阳性菌对头孢唑林、苯唑西林、青霉素、阿奇霉素的耐药率均较高≥50.0%,对万古霉素的耐药率为0。结论颅脑创伤患者行气管切开术后,发生下呼吸道感染的概率较高,病原菌主要以革兰阴性菌为主,其次为革兰阳性菌与真菌,为降低该疾病临床感染的病死率,应及时采取有效的治疗措施,合理应用抗菌药物。
[Abstract]:Objective to monitor the infection rate of lower respiratory tract in patients with craniocerebral trauma after tracheotomy, and to analyze the distribution of pathogenic bacteria in order to provide reference for clinical treatment. Methods 86 patients with craniocerebral trauma admitted in our hospital from December 2013 to March 2015 were treated with tracheotomy. The sputum samples were collected after operation for pathogen culture. The infection rate of lower respiratory tract was monitored and the distribution of pathogens and drug resistance were analyzed. Results there were 59 cases of lower respiratory tract infection in 86 patients with craniocerebral trauma, the infection rate was 68.6%, 72 strains of pathogenic bacteria were detected, 52 strains of Gram-negative bacteria accounted for 73.2%, 13 strains of Gram-positive bacteria accounted for 18.1, 7 strains of fungi accounted for 9.7%, and the gram-negative bacteria were Pseudomonas aeruginosa. Klebsiella pneumoniae and Acinetobacter baumannii were the main bacteria, with 16.718.1% and 23.6% respectively. Gram-positive bacteria were mainly Staphylococcus aureus (6.9%), fungi mainly were Candida albicans (6.9%), and the main gram-negative bacteria were ceftriaxone. Ciprofloxacin and meloxicillin showed high drug resistance, the resistance rate was 50.0 and the resistance rate to imipenem was 15.0. The main gram-positive bacteria were cefazolin, oxacillin and penicillin. The resistance rates of azithromycin to vancomycin and vancomycin were higher than or equal to 50.0, respectively. Conclusion the probability of lower respiratory tract infection is higher in patients with craniocerebral trauma after tracheotomy. The main pathogens are Gram-negative bacteria, followed by Gram-positive bacteria and fungi, in order to reduce the mortality of clinical infection. Effective treatment measures should be taken in time and rational use of antimicrobial agents should be made.
【作者单位】：义乌市中心医院神经外科;浙江大学附属第一医院呼吸科;
【基金】：浙江省医药卫生科技计划基金资助项目(2012QDF238)
【分类号】：R651.15

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