CAJ | 학술논문

目的：对神经外科重症监护病房（ NICU）内重型颅脑损伤患者发生肺部感染的相关危险因素及病原学分析，为防治肺部感染提供依据。方法回顾性分析NICU内收住的297例重型颅脑损伤患者的临床资料，统计院内肺部感染的发生率并分析发生的危险因素，对病原学检测结果进行分析，采取针对性防治措施。结果 NICU内重型脑损伤患者院内肺部感染59例，发生率为19.9％，肺部感染的发生受到患者年龄、昏迷程度（ GCS评分）、入住时间、机械通气、气管切开、是否手术、合并基础疾病以及吸烟史的影响（ P＜0.05）； G＋菌及多重耐药菌感染呈上升趋势。结论针对重型颅脑损伤患者发生肺部感染的危险因素，并根据病原菌分布，采取严格的消毒隔离措施，规范使用抗菌药物，是降低院内感染发生率的关键。
목적：대신경외과중증감호병방（ NICU）내중형로뇌손상환자발생폐부감염적상관위험인소급병원학분석，위방치폐부감염제공의거。방법회고성분석NICU내수주적297례중형로뇌손상환자적림상자료，통계원내폐부감염적발생솔병분석발생적위험인소，대병원학검측결과진행분석，채취침대성방치조시。결과 NICU내중형뇌손상환자원내폐부감염59례，발생솔위19.9％，폐부감염적발생수도환자년령、혼미정도（ GCS평분）、입주시간、궤계통기、기관절개、시부수술、합병기출질병이급흡연사적영향（ P＜0.05）； G＋균급다중내약균감염정상승추세。결론침대중형로뇌손상환자발생폐부감염적위험인소，병근거병원균분포，채취엄격적소독격리조시，규범사용항균약물，시강저원내감염발생솔적관건。
Objective To analyze the risk factors of pulmonary infection in severe brain injury patients in Neurosurgery Intensive Care Unit ( NICU) ,and to strengthen the clinical measures to prevent pulmonary infections . Methods The clinical data of 297 serious brain injury patients hospitalized in the NICU of Taixing Hospital Affilia-ted to Yangzhou University from Jan .2012 to Jan.2013 were analyzed retrospectively . The clinical prevention measures were taken according to the corresponding risk factors .Results The incidence rate of nosocomial pulmo-nary infection in severe brain injury patients was 19.9%.The pulmonary infection occurrence was correlated with patients’ age,the score of Glasgow Coma Scale,mechanical ventilation,tracheotomy,length of stay in NICU,com-bined underlying disease,operation treatment and smoking history (P<0.05).Gram-positive bacteria and multi-drug resistant bacteria infection were on the rise .Conclusion The advanced age,coma,mechanical ventilation, tracheotomy,long time staying in NICU ,combined underlying disease ,operation treatment , and smoking history are risk factors for the nosocomial pulmonary infections in patients with severe brain injury .Strict disinfection and isola-tion in NICU and appropriate preventive measures should be taken to reduce the incidence of pulmonary infection and to promote patients ’ rehabilitation .