神经外科重症患者医院获得性肺炎临床分析

发布时间：2018-03-28 15:23

本文选题：神经外科　切入点：重症患者　出处：《新乡医学院》2017年硕士论文

【摘要】：目的探讨神经外科重症患者医院获得性肺炎(HAP)的相关危险因素、病原菌特点及防治策略,为本地区重症医学科神经外科患者院内获得性肺炎的防治提供依据。方法以2014年11月到2016年10月河南省偃师市人民医院神经外科入住重症医学科的986例患者(排除社区获得性肺炎和住院不超48小时患者)的临床资料进行回顾性分析,统计HAP的发生率并分析相关危险因素、病原学检测结果。结果共有163例患者合并院内获得性肺炎,发生率为16.5%。常见HAP危险因素有:高龄、昏迷、气管插管、吸烟、偏瘫、恶心呕吐、气管切开、误吸、肺挫伤、机械通气、镇痛镇静等,其中昏迷、误吸是独立危险因素。HAP早期("f4天)常见病原菌以肺炎链球菌、流感嗜血杆菌为主。晚期(4天)常见病原菌为革兰氏阴性杆菌,以肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌、嗜麦芽假单胞菌为主,革兰氏阳性球菌以金黄色葡萄球菌为主。药敏实验以肺炎克雷伯菌及鲍曼不动杆菌多重耐药较多。结论尽早恢复患者意识,防止误吸,适当镇痛镇静保持呼吸道通畅及良好的咳嗽反射,合理应用抗菌素,执行严格的消毒隔离措施,结合肺部康复理疗是防治神经外科重症患者HAP的有效手段。
[Abstract]:Objective to investigate the risk factors, pathogen characteristics and prevention and treatment of hospital acquired pneumonia (HAP) in patients with severe neurosurgery. To provide the basis for the prevention and treatment of nosocomial pneumonia of neurosurgery patients in our region. Methods 986 patients (ranked) who were admitted to the Department of intensive Medicine from November 2014 to October 2016 in the people's Hospital of Yanshi City, Henan Province, were selected for the prevention and treatment of nosocomial pneumonia. With the exception of community-acquired pneumonia and hospitalized patients of not more than 48 hours, the clinical data were retrospectively analyzed. Results there were 163 patients with nosocomial pneumonia, the incidence rate was 16.55.The common risk factors of HAP were: old age, coma, tracheal intubation, smoking, hemiplegia. Nausea and vomiting, tracheotomy, aspiration, lung contusion, mechanical ventilation, analgesia and sedation, among which coma and aspiration are independent risk factors. Haemophilus influenzae were the most common pathogens. The common pathogens were Gram-negative bacilli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas maltophilia. Gram-positive cocci were mainly Staphylococcus aureus. Drug susceptibility tests were more resistant to Klebsiella pneumoniae and Acinetobacter baumannii. Conclusion patients' consciousness can be recovered as soon as possible to prevent accidental aspiration. Proper analgesia and sedation to keep respiratory tract patency and good cough reflex, rational use of antibiotics, strict disinfection and isolation measures, combined with pulmonary rehabilitation physiotherapy are effective measures to prevent and treat HAP in neurosurgery patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651

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