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目的探讨神经外科患者重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素和耐药状况,为临床预防和治疗提供依据。方法回顾性分析2012年1月—2015年12月神经外科收治的101例脑部术后继发肺部感染鲍曼不动杆菌患者的临床资料,调查相关危险因素,并采用纸片扩散法测定菌株对抗菌药物的敏感性,数据采用采用SPSS 20.0软件进行统计学分析。结果分析发现,糖尿病史、低蛋白血症、GCS评分、ICU住院天数、抗菌药物种数及累积用药天数、气管切开时间是肺部感染鲍曼不动杆菌的危险因素(P<0.01)。药敏结果显示,鲍曼不动杆菌对头孢哌酮钠/舒巴坦钠的敏感率最高,为71.34%,其次阿米卡星和亚胺培南,敏感率分别为55.41%和51.59%。结论神经外科患者重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素较多,在临床工作中,应采取相应措施减少鲍曼不动杆菌感染的发生。鲍曼不动杆菌多重耐药严重,头孢哌酮钠/舒巴坦钠仍是敏感性最高的药物,其次是阿米卡星和亚胺培南,宜根据药敏试验结果选用。
Objective To investigate the risk factors and drug resistance of Acinetobacter baumannii infection in patients with severe craniocerebral injury in neurosurgical patients and provide the basis for clinical prevention and treatment. Methods The clinical data of 101 patients with Acinetobacter baumannii infection after brain surgery admitted to Department of Neurosurgery from January 2012 to December 2015 in our hospital were retrospectively analyzed. The risk factors were investigated and examined by disk diffusion Strain antibacterial susceptibility, the data using SPSS 20.0 software for statistical analysis. Results showed that the history of diabetes mellitus, hypoalbuminemia, GCS score, ICU days of hospitalization, number of antibiotics and days of cumulative medication, and tracheotomy time were risk factors of pulmonary infection with Acinetobacter baumannii (P <0.01). Susceptibility results showed that Acinetobacter baumannii had the highest sensitivity to cefoperazone sodium / sulbactam sodium at 71.34%, followed by amikacin and imipenem at rates of 55.41% and 51.59%, respectively. Conclusion There are many risk factors for pulmonary infection of Acinetobacter baumannii in patients with severe craniocerebral injury in neurosurgical patients. In clinic, appropriate measures should be taken to reduce the incidence of Acinetobacter baumannii infection. Acinetobacter baumannii multi-drug resistance is serious, cefoperazone sodium / sulbactam sodium is still the most sensitive drug, followed by amikacin and imipenem, should be based on drug susceptibility test results.