颅脑手术后患者下呼吸道感染的病原菌分析和护理对策

摘要

Objective To analyze the characteristics of lower respiratory tract infection occurring in patients after craniocerebral surgery in Intensive Care Unit (ICU) and explore its nursing countermeasures. Methods Sixty-eight patients with lower respiratory tract infection after craniocerebral surgery in the ICU of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to March 2016 were selected as the study subjects. All patients were treated with dehydration to reduce intracranial pressure, hemostasis, anti-infection, anti-epilepsy, mild hypothermia, hypoglycemia and other symptomatic supportive treatments, and the corresponding nursing measures were given. The patients' primary diseases and etiological examination results were analyzed. Results Of the 68 patients complicated with lower respiratory tract infection after craniocerebral surgery, the majority of primary disease was craniocerebral injury, accounting for 45.59% (31/68). A total of 127 strains of pathogenic bacteria were isolated, mainly Gram-negative (G-) bacteria [92 strains (accounting for 72.44% )];followed by Gram-positive (G+) bacteria [19 strains (accounting for 14.96%)] and fungi [16 strains (accounting for 12.60%)]. The main pathogens of G- were Acinetobacter baumannii 21 strains (accounting for 23.14%), Klebsiella pneumoniae 13 strains (accounting for 14.94%), Burkholderia cepacia 10 strains (accounting for 11.49%), Pseudomonas aeruginosa 8 strains (accounting for 11.49%); the main pathogens of G+ was Staphylococcus aureus 6 strains (accounting for 5.89%). Conclusion The incidence of lower respiratory tract infection in ICU patients after craniocerebral surgery is high. It is necessary to prevent and control the related risk factors as soon as possible, and take energetic and effective nursing measures to reduce the incidence of lower respiratory tract infection.%目的 分析重症加强治疗病房(ICU)颅脑手术患者发生下呼吸道感染的特点并探讨其护理对策.方法 选择温州医科大学附属第一医院ICU 2015年1月至2016年3月收治的发生下呼吸道感染的68例颅脑手术患者.所有患者术后均采取脱水降颅压、止血、抗感染、抗癫痫、亚低温、降血糖和其他对症支持治疗,并给予相应的护理措施,分析患者的原发病及病原学检查结果.结果 68例颅脑手术后并发下呼吸道感染患者中,原发病以颅脑损伤居多为31例,占45.59%.共分离出病原菌127株,以革兰阴性(G-)菌为主〔92株(占72.44%)〕;其次是革兰阳性(G+)菌〔19株(占14.96%)〕;真菌〔16株(占12.60%)〕.感染的病原菌中G-菌主要为鲍曼不动杆菌21株(占23.14%),肺炎克雷伯菌13株(占14.94%),洋葱伯克霍尔德菌10株(占11.49%),铜绿假单胞菌8株(占9.2%);感染的病原菌中G+菌主要为金黄色葡萄球菌6株(占5.89%).结论 IUC颅脑手术患者下呼吸道感染率高,应针对相关危险因素尽早进行预防控制,并采取积极有效的护理对策,以降低下呼吸道感染的发生率.