Abstract
Objective To explore the characteristics of respiratory tract flora and the influencing factors of pulmonary infection in patients with severe craniocerebral injury after tracheotomy.Methods A total of 68 patients with severe craniocerebral injury who underwent tracheotomy from January 2019 to December 2022 in the Second People's Hospital of Yangzhou were selected as subjects.Sputum of all patients at different time periods was collected and cultured to evaluate the changes of respiratory microflora.Patients were divided into pulmonary infection group(n=48)and non-pulmonary infection group(n=20)according to whether they were infected with lung disease.Detailed basic clinical data of patients were collected,and the factors of infection were analyzed by logistic regression.Results The incidence of pulmonary infection was high in patients with tracheotomy,48 cases(70.59％)were infected.With the change of time,the respiratory tract flora also changed,among which Klebsiella pneumoniae and Acinetobacter baumannii accounted for 43％and 14％on day 1,respectively.On day 4,Klebsiella pneumoniae and Serratia marcescens occupied the first two places,accounting for 41％and 14％,respectively.On day 7,Burkholderia cepacia and Klebsiella pneumoniae occupied the first two places,accounting for 27％and 24％,respectively.On day 10,Burkholderia cepacia and Klebsiella pneumoniae still occupied the first two places,accounting for 26％and 23％,respectively.On day 14,Burkholderia cepacia and Klebsiella pneumoniae still occupied the first two places,accounting for 28％and 25％respectively.The proportion of multidrug-resistant bacteria in Klebsiella pneumoniae at day 1,4,7 and 14 was increasing.The proportion of multidrug-resistant bacteria in Acineto-bacter baumannii and Burkholderia cepacia at the 1st,4th,7th and 10th day was increasing.The proportion of multi-drug-re-sistant bacteria in the 1st,4th and 7th days of Staphylococcus aureus was increasing.The percentages of age,coma duration ≥2 weeks,cerebral infarction,severe hypoproteinemia and mechanical ventilation duration≥2 weeks in the pulmonary infec-tion group were higher than those in the non-pulmonary infection group,early nutritional support,jejunal catheter indenta-tion in the pulmonary infection group were lower than that in the non-pulmonary infection group,with statistical signifi-cances(P＜0.05).Logistic regression analysis showed that age(β=0.354,OR=1.456,95％CI=1.164-1.799),coma dura-tion≥2 weeks([3=0.622,OR=1.865,95％CI=1.233-2.798),cerebral infarction(β=1.513,OR=2.463,95％CI=0.608-5.284)and severe hypoproteinemia(β=1.639,OR=3.417,95％CI=1.908-8.284)were the main risk factors for pulmonary infection in patients with severe craniocranial injury after tracheotomy.Early nutritional support(β=-0.373,OR=0.690,95％CI=0.168-5.178),indenting-jejunal tube(β=-2.476,OR=0.692,95％CI=0.912-6.931)were protective factors against infection(P＜0.05).Conclusion With the passage of time,the bacterial flora distribution and drug resistance will also change.The older the patient,the longer the coma duration,the more severe the hypoproteinemia and the cerebral infarction,the greater the risk of pulmonary infection.Early nutritional support,indenture of jejunal tube were protective factors against infection.关键词
重型颅脑损伤/气管切开/呼吸道/菌群变化/影响因素/痰液Key words
Severe craniocerebral injury/Tracheotomy/Respiratory tract/Microflora change/Influencing factors/Sputum分类
医药卫生
