神经外科ICU患者气管切开后肺部感染的实验室和临床研究.doc

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1、神经外科ICU患者气管切开后肺部感染的实验室和临床研究【关键词】ICU患者【摘耍】目的探讨神经外科ICU患者气管切开后肺部感染的相关因素和感染的病原体及药物敏感性。方法采用前瞻性和冋顾性的方法，对1996年1月〜2003年1月神经外科ICU患者气管切开后肺部感染的痰培养、药敏试验、ESBL、MRSA、PHRSP的监测和临床资料进行分析，并对铜绿假单胞菌和MRSA进行噬菌体分型。结果本纽•医院肺部感染发生率89%,大多数出现在气管切开后3〜6天，病死率显著高于无医院帥部感染者（PvO.05）,跚养出375株优势菌,其中革兰阴性杆菌210株、革兰阳性球菌86株、真菌79株，3次培养结果一致者按一

2、•株计算，79株真菌全部混合细菌感染。结论ICU患者气管切开后肺部感染与应用地塞米松、H2受体扌吉抗剂及酸泵抑制剂无关，与颅脑损伤程度、医院环境污染、细菌二重感染有关，应在1周内进行痰涂片检菌和培养,根据药破联合用药。关键词气管切开神经外科ICU肺部感染药敏试验vPstyle=,TEXT-INDENT:24pxnalign=center>Clinnicalandlaboratiystudyofhospitalinfectionoflunginsurgicalde

3、partmentofnurveinICUpatientsaftertracheotomyZiJinfen,ZhuDequanTheHealthCenterofLinYiEighthShcool,Shandong276003.[Abstract]ObjectiveTodiscusstherelevantfactorscausinghospitalinfectionoflunginsurgi

4、caldepartmentofnerveinICUpatientsaftertracheotomy.MethodsUsingprospectiveandretrospectivestudiestoanalyzeduring1996^2003yearsputumbacteriacultures,drugsensitivetestsandrelativeclinicaldataofl84cranialinjurypatients.ResultsIncidencerateofhospitalinfectionoflungwas89%inthisgroup.Mostoccurred（3〜6）days

5、aftertra一cheotomy.Thedeathrateofinfectedpatientsissignificantlyhigherthannon-infectedpatients（P<0.05）・375strainsofparhogenicbacteriawerefoundofthem21Ogram-negative、86gram-spostive、79fungi,79fungiallmixinfectionwithbacteria.ConclusionHospitalinfectionoflungincranialinjurypatientsaftertracheotomyisno

6、tre~latestouseofdexamethasone.H2receptorantagonistandacidpumpinhibitor,butisrelatedtoseriousnessofcranialinjury,environmentalpollutionofthehospitalandinfectioncausingbygram-negativebacteria.PreventionandcontrolshouldbedonewithinthefirstweekaftertracheotomywithactivetreatmentoforiginaldiseaseanduseI

7、CU.Alsoeffec~tivearecontrollingtheenvironmentcdpollutionofthehospitalandselectionofantibioticsbasedonantimicrobialsus一ceptibilitytestingtocontrolnosocomid.Keywordstracheotomysurgi