神经内科医院内肺部感染的治疗和预防.docVIP

神经内科医院内肺部感染的治疗和pulmonary infection in department of neurology 【Abstract】Objective:To study the difference of pathogen constitution and antibioticc sensitivety in in-patients with hospital-aquiredpneumonia HAP in the department of neurology.Methods:The in-patients suffering from HAP from August 2006 to december 2007 were collected in this study,and the diagnosis of HAP was made based on the respiratory specimen culture.The clinical data including the time of HAP onset,severity of illness,risk factors,isolated bacteria and antimicrobial sensitivity were analysed retrospectively.Resuits:A total of 115 patients with HAP were recruited,the most common pathogen of lung infection in early onset was klebsiella pneumoniae 28.6% ,Pseudomonas aeruginosa 14.2% and Bacillus coli 14.2% , while in alte onset it was Acinetobacter baumanii 30.0% Pseudomonss aeruginosa 15.0% and staphylococcus aureus 15.0% .Imipenem was the best monotherapy for early and late onset pneumonia 92%and 80%respetively .The sensitivity of imipenem plus vancomycin was 99%in early onset pneumonia and 97%in late on set one.Conclusion:Monotherapy with levofloxacin or the combined treatment of imipenem and vancomycin may be good option adinitia empirical therapy for the hospital-aquired pneumonia.the later is the best.. 【Key words】Pneumonia; Therapy; prevention 医院内肺部感染是指患者在住院过程中所发生的获得性肺炎,它既不包括入院时已存在的肺部感染,也不包括入院时正处在肺部感染潜伏期的病例。神经内科成功救治了许多危重患者的生命。肺部感染是入住神经内科患者中最常见的并发症之一，总体发病率约1% ~3%,病死率20% ~50%,是导致住院患者死亡的重要原因[1]。.1一般预防 保持室内空气清新,定期通风,防止交叉感染，注意保暖。患者宜取头稍高的侧卧位,防止口腔分泌物流入气管。床旁置吸引器,便于及时清理口腔分泌物,减少误吸的机会。 .2 严格执行消毒隔离制度 进行医疗预防操作时，认真落实各项消毒隔离措施特别是吸收措施，加强物品的清洁消毒，病人使用的雾化器、吸引器等专人专用，每24小时更换、消毒一次，吸氧吸痰采用一次性导管。 .3口腔预防 自理患者每日漱口1~2次,意识不清患者每日口腔预防2次,并注意有无溃疡及霉菌感染，有溃疡时及时处理。定期做咽拭子培养,发现问题,及时处理。 .4呼吸道管理 根据医嘱给氧。清醒者鼓励患者深呼吸及有效咳嗽。痰稠不易咳出者,可配合做呼吸道湿化及雾化,以利痰液咳出。对气管切开者,切口处保持清洁干燥，换药1~2次/d，被痰液浸渍的纱布随时更换，切口周围的皮肤用75乙醇棉球消毒2次/d。 参考文献： 1 刘小红，刘小艳.重型颅脑损伤并发肺炎的机制及预防[J].预防研究，2000,14（4）:15