CAJ | 학술논문

目的：了解重型颅脑损伤行气管切开后肺部感染患者下呼吸道痰液标本与护士留取标本洗手后手表标本主要分离病原菌的分布及相关性。方法收集于本院进行治疗的97例重型颅脑损伤气管切开后肺部感染患者的下呼吸道痰液标本及护士留取标本洗手后的手表标本，送微生物实验室分离培养病原菌并进行细菌鉴定，鉴定结果用WHONET5．4软件进行统计分析。结果共收集388份标本，其中痰液标本194份，护士手表标本194份。共分离得到病原菌633株，其中革兰阴性菌（G －菌）452株（71．41％），革兰阳性（G＋）菌134株（21．17％），真菌47株（7．42％）。引起下呼吸道感染所占比例排前5位的G－菌依次为铜绿假单胞菌（12．16％）、鲍曼不动杆菌（9．63％）、肺炎克雷伯菌（7．10％）、嗜麦芽窄食单胞菌（5．21％）、大肠埃希菌（4．89％）；主要G＋菌为凝固酶阴性葡萄球菌（6．79％）、金黄色葡萄球菌（2．36％）；真菌主要是白假丝酵母菌（4．24％）。护士手表分离细菌所占比例排前5位的G－菌依次是铜绿假单胞菌（6．79％）、鲍曼不动杆菌（5．84％）、大肠埃希菌（4．91％）、肺炎克雷佰菌（3．94％）、嗜麦芽窄食单胞菌（3．79％）；主要G＋菌主要是凝固酶阴性葡萄球菌（10．74％）、金黄色葡萄球菌（2．36％）；真菌主要是白假丝酵母菌（3．00％）。结论重型颅脑损伤气管切开后肺部感染患者，存在交叉感染的危险因素，应强化护士手卫生管理和无菌技术操作规程的遵守。
목적：료해중형로뇌손상행기관절개후폐부감염환자하호흡도담액표본여호사류취표본세수후수표표본주요분리병원균적분포급상관성。방법수집우본원진행치료적97례중형로뇌손상기관절개후폐부감염환자적하호흡도담액표본급호사류취표본세수후적수표표본，송미생물실험실분리배양병원균병진행세균감정，감정결과용WHONET5．4연건진행통계분석。결과공수집388빈표본，기중담액표본194빈，호사수표표본194빈。공분리득도병원균633주，기중혁란음성균（G －균）452주（71．41％），혁란양성（G＋）균134주（21．17％），진균47주（7．42％）。인기하호흡도감염소점비례배전5위적G－균의차위동록가단포균（12．16％）、포만불동간균（9．63％）、폐염극뢰백균（7．10％）、기맥아착식단포균（5．21％）、대장애희균（4．89％）；주요G＋균위응고매음성포도구균（6．79％）、금황색포도구균（2．36％）；진균주요시백가사효모균（4．24％）。호사수표분리세균소점비례배전5위적G－균의차시동록가단포균（6．79％）、포만불동간균（5．84％）、대장애희균（4．91％）、폐염극뢰백균（3．94％）、기맥아착식단포균（3．79％）；주요G＋균주요시응고매음성포도구균（10．74％）、금황색포도구균（2．36％）；진균주요시백가사효모균（3．00％）。결론중형로뇌손상기관절개후폐부감염환자，존재교차감염적위험인소，응강화호사수위생관리화무균기술조작규정적준수。
Objective To investigate the distribution of pathogens isolated from lower respiratory tract sputum samples of trach‐eotomy patients who suffered from severe craniocerebral injury and nurses′hands surface samples ,and analyze the correlation be‐tween them .Methods Lower respiratory tract sputum samples of 97 tracheotomy patients suffered from severe craniocerebral inju‐ry and hands surface samples from nurses who just washed their hands after the sample collection were collected .Then the samples were sent to the microbiological lab for pathogen isolation and identification ,the results were statistically analyzed by using WHO‐NET5.4software.Results 388sampleswerecollectedaltogether,including194sputumsamplesand194nurses′handssurface samples .633 pathogens were isolated altogether ,including 452 strains of G- bacteria (71 .41% ) ,134 strains of G+ bacteria (21 .17% ) and 47 strains of fungi(7 .42% ) .The top five species of G- bacteria which took the largest proportion and caused the lower respiratory tract infection were Peudomonas aeruginosa(12 .16% ) ,Acinetobacter baumannii(9 .63% ) ,Klebsiella pneumoniae bacteria(7 .10% ) ,Stenotrophomonas maltophilia(5 .21% ) ,Escherichia coli(4 .89% );the primary species of G+ bacteria were coag‐ulase negative staphylococcus(6 .79% ) ,Staphylococcus aureus(2 .36% );the primary fungus was Monilia albicans(4 .24% ) .The top five G- bacteria species which took the largest proportion and isolated from hands surface samples were Pseudomonas aeruginosa (6 .79% ) ,Acinetobacter baumannii(5 .84% ) ,Escherichia coli(4 .91% ) ,Klebsiella pneumoniae(3 .94% ) ,Stenotrophomonas malto‐philia(3 .79% );the primary species of G+ bacteria were coagulase negative staphylococcus (9 .63% ) ,Staphylococcus aureus (2 .36% ) .The primary fungus was Monilia albicans(3 .00% ) .Conclusion Tracheotomy patients who suffered from severe cranio‐cerebral injury with lower respiratory infection are very possible to have cross‐infection ,sanitary management of nurses′hands asep‐tic manipulation procedures should be strengthened .