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目的 探讨预防长期卧床老年脑功能障碍患者院内获得性肺感染的对策。方法 收集 1995年 12月～1999年 10月共 12例长期住院的老年患者 ,伴有脑血栓、脑出血、脑肿瘤或脑炎 ;依设定之院内获得性肺感染诊断标准明确诊断并留取痰液培养。结果 12例患者全部罹患院内获得性肺感染 ,反复多次 ,以右侧多见 ;痰培养共分离出 2 0种细菌菌株 ,其中以铜绿假单胞菌、大肠埃希菌、草绿色链球菌较多见 ,药敏试验提示它们多对氨基糖苷类抗生素及亚胺培南敏感 ,对头孢二代及头孢三代等抗 G- 杆菌抗生素耐药 ;这些患者因反复罹患院内获得性肺感染导致 5 0 %的患者死亡 ,另外 5 0 %患者由于气管切开或气管插管而滞留于医院。结论 长期住院老年患者 ,尤其是伴有脑功能受损的患者 ,防治院内获得性肺感染是值得重视的一个问题 ,直接关系到患者的预后 ,应将其作为康复治疗的重要环节。
Objective To investigate the strategy of preventing nosocomial pulmonary infection in long-term bedridden senile patients with brain dysfunction. Methods A total of 12 elderly patients with long-term hospitalization from December 1995 to October 1999 were collected, with cerebral thrombosis, cerebral hemorrhage, brain tumor or encephalitis. According to the diagnostic criteria of nosocomial acquired pulmonary infection Sputum culture. Results All 12 patients were infected with nosocomial pulmonary infection, repeated many times to the right of more common; sputum culture were isolated 20 kinds of bacterial strains, of which Pseudomonas aeruginosa, Escherichia coli, Streptococcus viridans More common, drug susceptibility tests suggest that they are more sensitive to aminoglycoside antibiotics and imipenem against cephalosporins and cephalosporins three generations of anti-G-bacilli antibiotic resistance; these patients due to recurrent nosocomial lung infections caused by 5 0% of the patients died, while 50% of patients died in the hospital due to tracheotomy or endotracheal intubation. Conclusion Long-term hospitalization of elderly patients, especially those with impaired brain function, prevention and treatment of acquired pulmonary infection is a problem worthy of attention, which is directly related to the prognosis of patients and should be taken as an important part of rehabilitation.