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目的了解颅脑损伤患者气管切开术后下呼吸道感染特点和危险因素,以便采取有效预防与控制措施。方法对住院颅脑损伤全气管切开术后40例患者进行调查分析,对病原学标本进行细菌培养和药敏试验,调查下呼吸道感染情况,分析其相关危险因素。结果 40例患者中发生医院感染29例次,医院感染例次率为72.5%,以下呼吸道感染占首位(例次感染率82.75%),病原菌以革兰阴性菌为主,共35株,占76.1%,其次革兰阳性球菌6株,占13.0%,真菌5株,占10.9%;调查患者均有严重的基础疾病及行气管插管、气管切开、吸痰等治疗,气管切开置管时间越长、住院天数越多、下呼吸道感染率越高,与不合理使用抗菌药物密切相关。结论气管插管、气管切开、气管切开置管时间长、住院天数多、抗菌药物使用不合理等是下呼吸道感染发生的危险因素;加强无菌技术操作,提高患者自身免疫力,缩短置管时间及住院天数,合理应用抗菌药物,可降低医院感染发病率。
Objective To understand the characteristics and risk factors of lower respiratory tract infection after tracheotomy in traumatic brain injury in order to take effective preventive and control measures. Methods 40 cases of traumatic brain injury after tracheotomy were investigated and analyzed. Bacterial culture and drug sensitivity test were performed on the etiological specimens. The lower respiratory tract infection was investigated and the related risk factors were analyzed. Results Of the 40 cases, nosocomial infections occurred in 29 cases, the rate of nosocomial infections was 72.5%, and the following respiratory infections were the most common (nosocomial infection rate was 82.75%). Gram-negative bacteria were the main pathogenic bacteria, accounting for 76.1 %, Followed by Gram-positive cocci 6, accounting for 13.0%, fungi 5, accounting for 10.9%; survey patients have a serious underlying diseases and endotracheal intubation, tracheostomy, suction and other treatment, tracheotomy tube The longer the duration of hospitalization, the lower the rate of lower respiratory tract infection, and unreasonable use of antibacterial drugs are closely related. Conclusions Endotracheal intubation, tracheotomy, tracheotomy and catheterization for a long time, hospitalization days, unreasonable use of antimicrobial agents and other risk factors for lower respiratory tract infection; strengthen the aseptic technique to improve the patient’s own immunity, shorten the set Tube time and length of stay, rational use of antimicrobial agents, can reduce the incidence of nosocomial infections.