摘要
目的调查重症监护病房（ICU）重型颅脑损伤后颅内感染患者肺部感染的临床特点以及危险因素，以制定预防治疗对策，降低感染率。方法选取2007年4月-2012年6月人住ICU180例重型颅脑损伤后颅内感染患者为研究对象，采集其一般资料如年龄、性别等及病例特征如住院时间、抗菌药物、使用呼吸机、气管切开、创伤前有休克、多发损伤、合并基础疾病及病原学检查等，采用单因素和非条件logistic回归分析，模型筛选采用Step—wise法；评价影响ICU中重型颅脑损伤后颅内感染患者肺部感染的危险因素。结果logistic回归分析显示，年龄较大（OR=1．769，95％CI：1．4202．115）、住院时间长（OR=6．447，95％CI：1．826～22．769）、使用呼吸机（0R=1．863，95％CI：1．709～2．051）、气管切开（OR=1．539，95％CI：1．042～2．635）、创伤前有休克（OR=3．640，95％CI：2．169～6．193）以及基础疾病（OR=4．632，95％CI：2．357～6．103）为重型颅脑损伤后颅内感染患者肺部感染的危险因素；病原菌以革兰阴性菌为主57株占63．3％，革兰阳性菌23株占25．6％，真菌10株占11．1％。结论导致重型颅脑损伤后颅内感染患者肺部感染的主要因素有年龄、住院时间、气管切开、休克、基础病变等，其主要病原菌为革兰阴性菌，其次为革兰阳性菌、真菌，随时间延后，细菌耐药性增强。
OBJECTIVE To investigate clinical characteristics and risk factors for pulmonary infections in severe craniocerebral injury patients complicated with intracranial infections in intensive care unit （ICU） so as to put forward corresponding countermeasures and reduce the infection rate. METHODS A total of 180 craniocerebral injury patients complicated with intracranial infections, who were hospitalized in the ICU from Apr 2007 to Jun 2012, were enrolled in the study, the general materials were collected such as age, gender, case characteristics including length of hospital stay, antibiotics, use of Ventilator, tracheotomy, trauma before shock, multiple injury, as well as basic diseases and etiology inspection. The single factor and unconditional logistic regression analysis were performed, and model screening was carried out with the use of stepwise method. The risk factors for the pulmonary infections in intracranial infection patients after severe craniocerebral injury were evaluated in the ICU. RESULTS As the results of logistic regression analysis, advanced age （OR=1. 769, 95% CI： 1. 420-2. 115）, longer hospital stay （OR=6. 447, 95% CI： 1. 826-22. 769）, use of ventilator （OR=1. 863, 95%CI： 1. 709-2. 051）, traeheotomy （OR=1. 539 95% CI： 1. 042-2. 635）, shock pre-trauma （OR=3. 640, 95% CI： 2. 169-6. 193 and with basic diseases （OR=4. 632, 95% CI： 2. 357-6. 103） were the risk factors for pulmonary infections in intracranial infection patients after heavy craniocerebral injury. The gram-negative bacteria were the major pathogens （57 stains, 63.3 %）, and 23 strains were gram positive bacteria accounting for 25.6 %, 10 strains were fungi, accounting for 11. 1%. CONCLUSION The main factors for pulmonary infections in intracranial infection patients after heavy cranioeerebral injury are the age, length of hospital stay, tracheotomy, shock, basic lesions, etc, and the main pathogens are the gram negative bacteria, followed by gram-positive bacteria, fungi. The bacte rial resistance is increased with the time.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第23期5711-5713,共3页
Chinese Journal of Nosocomiology
基金
山东省医学领军人才培养工程传销基金资助项目(ts20110814)
关键词
重症监护病房
颅脑损伤
颅内感染
肺部感染
危险因素
Intensive care unit
Craniocerebral injury
Intracranial infection
Pulmonary infection
Risk factor
