本文選題：神經(jīng)外科　切入點：重癥患者　出處：《新鄉(xiāng)醫(yī)學院》2017年碩士論文

【摘要】：目的探討神經(jīng)外科重癥患者醫(yī)院獲得性肺炎(HAP)的相關危險因素、病原菌特點及防治策略,為本地區(qū)重癥醫(yī)學科神經(jīng)外科患者院內(nèi)獲得性肺炎的防治提供依據(jù)。方法以2014年11月到2016年10月河南省偃師市人民醫(yī)院神經(jīng)外科入住重癥醫(yī)學科的986例患者(排除社區(qū)獲得性肺炎和住院不超48小時患者)的臨床資料進行回顧性分析,統(tǒng)計HAP的發(fā)生率并分析相關危險因素、病原學檢測結(jié)果。結(jié)果共有163例患者合并院內(nèi)獲得性肺炎,發(fā)生率為16.5%。常見HAP危險因素有:高齡、昏迷、氣管插管、吸煙、偏癱、惡心嘔吐、氣管切開、誤吸、肺挫傷、機械通氣、鎮(zhèn)痛鎮(zhèn)靜等,其中昏迷、誤吸是獨立危險因素。HAP早期("f4天)常見病原菌以肺炎鏈球菌、流感嗜血桿菌為主。晚期(4天)常見病原菌為革蘭氏陰性桿菌,以肺炎克雷伯菌、鮑曼不動桿菌、銅綠假單胞菌、大腸埃希菌、嗜麥芽假單胞菌為主,革蘭氏陽性球菌以金黃色葡萄球菌為主。藥敏實驗以肺炎克雷伯菌及鮑曼不動桿菌多重耐藥較多。結(jié)論盡早恢復患者意識,防止誤吸,適當鎮(zhèn)痛鎮(zhèn)靜保持呼吸道通暢及良好的咳嗽反射,合理應用抗菌素,執(zhí)行嚴格的消毒隔離措施,結(jié)合肺部康復理療是防治神經(jīng)外科重癥患者HAP的有效手段。
[Abstract]:Objective to investigate the risk factors, pathogen characteristics and prevention and treatment of hospital acquired pneumonia (HAP) in patients with severe neurosurgery. To provide the basis for the prevention and treatment of nosocomial pneumonia of neurosurgery patients in our region. Methods 986 patients (ranked) who were admitted to the Department of intensive Medicine from November 2014 to October 2016 in the people's Hospital of Yanshi City, Henan Province, were selected for the prevention and treatment of nosocomial pneumonia. With the exception of community-acquired pneumonia and hospitalized patients of not more than 48 hours, the clinical data were retrospectively analyzed. Results there were 163 patients with nosocomial pneumonia, the incidence rate was 16.55.The common risk factors of HAP were: old age, coma, tracheal intubation, smoking, hemiplegia. Nausea and vomiting, tracheotomy, aspiration, lung contusion, mechanical ventilation, analgesia and sedation, among which coma and aspiration are independent risk factors. Haemophilus influenzae were the most common pathogens. The common pathogens were Gram-negative bacilli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas maltophilia. Gram-positive cocci were mainly Staphylococcus aureus. Drug susceptibility tests were more resistant to Klebsiella pneumoniae and Acinetobacter baumannii. Conclusion patients' consciousness can be recovered as soon as possible to prevent accidental aspiration. Proper analgesia and sedation to keep respiratory tract patency and good cough reflex, rational use of antibiotics, strict disinfection and isolation measures, combined with pulmonary rehabilitation physiotherapy are effective measures to prevent and treat HAP in neurosurgery patients.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651

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