论文部分内容阅读
目的探讨急诊重症监护室(EICU)高血压脑出血并发肺部感染的相关因素和集束化干预效果。方法选取2015年1-12月本院EICU收治的高血压所致脑出血患者294例,对其中继发肺部感染的56例进行病原菌和危险因素分析,根据结果制定集束化干预方案。选取2016年1-12月本院EICU收治的高血压所致脑出血并发肺部感染患者60例,分为研究组(集束化照护干预)和对照组(常规照护),比较两组患者肺部感染时间、气管置管时间、EICU入住时间以及死亡病例数。结果 56例继发肺部感染患者分泌物标本中共检出病原菌72株,其中以肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌为主;年龄≥60岁,合并慢性阻塞性肺疾病(COPD)、糖尿病,有意识障碍、侵入性操作、反复吸痰、住院时间≥15 d均为高血压所致脑出血患者肺部感染的独立危险因素(P<0.05)。给予集束化干预的研究组患者肺部感染时间、气管置管时间、EICU入住时间和死亡率均明显低于常规照护的对照组患者,差异有统计学意义(P<0.05)。结论高血压脑出血并发肺部感染致病菌以革兰阴性菌为主,根据主要病原菌和危险因素制定的集束化干预方案可有效促进患者病情恢复,降低死亡率。
Objective To explore the related factors of intensive care unit (ICU) hypertensive intracerebral hemorrhage complicated by pulmonary infection and the effect of cluster intervention. Methods From January to December in 2015, 294 patients with hypertensive cerebral hemorrhage admitted from EICU hospital were enrolled. Pathogenic bacteria and risk factors were analyzed in 56 patients with secondary pulmonary infection. According to the results, a cluster intervention program was established. Sixty patients with intracerebral hemorrhage complicated with pulmonary infection caused by hypertension in our hospital from January to December in 2016 were enrolled in this study. The patients were divided into study group (intervention group) and control group (routine care group) Infection time, endotracheal tube time, EICU admission time and the number of deaths. Results Seventy-two pathogens were detected in secretions from 56 patients with secondary pulmonary infection, of which Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa were the main pathogens, age≥60 years, with chronic obstructive Pulmonary disease (COPD), diabetes mellitus, disturbance of consciousness, invasive procedure, repeated sputum aspiration, and hospital stay ≥15 d were independent risk factors for pulmonary infection in patients with hypertensive cerebral hemorrhage (P <0.05). Pulmonary infection time, tracheal catheterization time, EICU admission time and mortality in the study group receiving intensive intervention were significantly lower than those in the routine care group (P <0.05). Conclusions Gram-negative bacteria are the main pathogens of Hypertensive intracerebral hemorrhage complicated with pulmonary infection. The cluster intervention program based on major pathogens and risk factors can effectively promote the recovery of patients and reduce the mortality rate.