ICU多发伤患者合并肺部感染原因分析与治疗对策
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摘要
目的分析ICU多发伤患者合并肺部感染的主要原因,总结有效的治疗对策。方法回顾性分析该院2014年1月—2018年6月期间收治的35例ICU多发伤合并肺部感染患者临床资料,分析患者细菌培养及药敏试验结果及治疗方法及效果。结果误吸、原发伤或创伤后急救、不合理应用抗生素、侵入性操作、手术治疗等是导致ICU多发伤合并肺部感染的常见原因。该次35例患者取标本共76次,培养分离病原菌36株,其中念珠菌1株(2.4%),对伏立康唑、氟康唑、伊曲康唑等药物较为敏感;G阳性球菌13株(36.1%),对万古霉素、替考拉宁等药物较为敏感;G阴性杆菌22株(61.1%),对美罗培南、亚胺培南、替加环素等药物较为敏感。经相应治疗,抢救无效死亡患者5例,死亡率14.3%,其余30例患者病情均得到有效控制,最后顺利出院。结论 ICU多发伤患者积极治疗原发伤,给予呼吸辅助支持,早期进行气管切开,合理应用抗生素,加强呼吸道管理,有利于预防肺部感染,改善患者预后。
Objective To analyze the main causes of pulmonary infection in patients with multiple trauma in ICU, and to summarize effective treatment strategies. Methods The clinical data of 35 patients with multiple ICU and pulmonary infection who were admitted to our hospital from January 2014 to June 2018 were retrospectively analyzed. The results of bacterial culture and drug susceptibility test, treatment methods and effects were analyzed. Results Aspiration, primary or posttraumatic first-aid, unreasonable application of antibiotics, invasive procedures, and surgical treatment are common causes of multiple injuries and pulmonary infections in ICU. In this 35 cases, a total of 76 specimens were taken and 36 pathogens were isolated and cultured, of which 1 strain of candida(2.4%) was sensitive to voriconazole, fluconazole, itraconazole and other drugs; 13 strains of G-positive cocci(36.1%), sensitive to vancomycin, teicoplanin and other drugs; G-negative bacilli22(61.1%), sensitive to meropenem, imipenem, tigecycline and other drugs. After corresponding treatment, 5 patients with dead death were rescued, and the mortality rate was 14.3%. The remaining 30 patients were effectively controlled and finally discharged. Conclusion Patients with multiple trauma in ICU actively treat primary injury, give respiratory support, early tracheotomy, rational use of antibiotics, and strengthen respiratory management, which is beneficial to prevent lung infection and improve patient prognosis.
Objective To analyze the main causes of pulmonary infection in patients with multiple trauma in ICU, and to summarize effective treatment strategies. Methods The clinical data of 35 patients with multiple ICU and pulmonary infection who were admitted to our hospital from January 2014 to June 2018 were retrospectively analyzed. The results of bacterial culture and drug susceptibility test, treatment methods and effects were analyzed. Results Aspiration, primary or posttraumatic first-aid, unreasonable application of antibiotics, invasive procedures, and surgical treatment are common causes of multiple injuries and pulmonary infections in ICU. In this 35 cases, a total of 76 specimens were taken and 36 pathogens were isolated and cultured, of which 1 strain of candida(2.4%) was sensitive to voriconazole, fluconazole, itraconazole and other drugs; 13 strains of G-positive cocci(36.1%), sensitive to vancomycin, teicoplanin and other drugs; G-negative bacilli22(61.1%), sensitive to meropenem, imipenem, tigecycline and other drugs. After corresponding treatment, 5 patients with dead death were rescued, and the mortality rate was 14.3%. The remaining 30 patients were effectively controlled and finally discharged. Conclusion Patients with multiple trauma in ICU actively treat primary injury, give respiratory support, early tracheotomy, rational use of antibiotics, and strengthen respiratory management, which is beneficial to prevent lung infection and improve patient prognosis.
引文
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[12]段俊斐,何永辉,罗欣民,等.ICU多发伤患者合并肺部感染原因分析与治疗对策[J].中国继续医学教育,2017,9(22):155-156.
[2] Lu Guangxuan.Clinical value of controlled boost and restrictive fluid resuscitation in multiple traumatic shock in ICU[J].Modern Diagnosis&Treatment,2016,27(4):721-722.
[3]成杨.分析ICU治疗严重多发伤患者的临床效果[J].中国保健营养,2017,27(18):135-136.
[4]李璐奕,黄瑾,王建,等.临床药师参与ICU多发伤患者的治疗体会[J].海南医学,2015,26(9):1376-1379.
[5]郭鹏丽,蔡素因,陈辉民,等.综合ICU多发伤呼吸机相关性肺炎的危险因素研究[J].中国临床护理,2015,7(6):474-476.
[6]杨晓华,王恺.ICU患者发生医院感染的特点、危险因素及护理措施[J].长春中医药大学学报,2016,32(1):176-178.
[7]黄文全,段兆聪,李家品,等.床旁纤维支气管镜ICU中治疗严重肺部感染的应用[J].中国伤残医学,2014,22(2):138.
[8]邓岚,杨丽,温泉丽,等.严重多发伤患者气管切开术后的肺部感染预防与护理[J].世界最新医学信息文摘,2014,14(31):502-503.
[9] Wang Yingzhong,Zhang Yang.Observation on the application effect of injury control surgical technique in emergency treatment of multiple trauma in emergency surgery[J].China Continuing Medical Education,2016,8(5):106-108.
[10]徐俊,袁明德.严重多发伤的急救救治经验综述[J].中国医药指南,2015(8):38-39.
[11]陈国清.47例ICU多发伤患者合并肺部感染原因分析与治疗对策[J].中国现代医学杂志,2012,22(12):93-95.
[12]段俊斐,何永辉,罗欣民,等.ICU多发伤患者合并肺部感染原因分析与治疗对策[J].中国继续医学教育,2017,9(22):155-156.