脑外伤患者气管切开后肺部感染因素分析及护理对策

吴敏 刘会玲 徐小红

[摘要]目的 探討脑外伤患者采取气管切开救治方法后引发肺部感染的因素，评价针对性护理干预在肺部感染患者中的应用价值。方法 选取2015年2月～2017年5月我院收治的80例脑外伤气管切开患者作为本研究对象，重点分析比较肺部感染患者（n=27）与非感染患者（n=53）的格拉斯哥（GCS）评分、白蛋白、气管切开时间、病史等临床资料。对肺部感染患者采用针对性护理干预对策，对非感染患者采用常规护理方法，比较两组的护理满意度。结果 单因素分析结果提示，感染组和非感染组的吸烟史、糖尿病史、胃管留置、合并伤、预防性应用抗生素、应用激素、GCS评分、气管切开时间、清蛋白水平的比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果发现，脑外伤患者气管切开后肺部感染的独立危险因素为气管切开时间越长、GCS评分越低、使用激素、糖尿病病史，差异有统计学意义（P<0.05），吸烟史、胃管留置、合并伤、预防性应用抗生素、清蛋白水平，差异无统计学意义（P>0.05）。感染组患者的总满意度低于非感染组，但差异无统计学意义（χ2=0.200，P>0.05）。结论 脑外伤患者气管切开后肺部感染的影响因素较多，其中激素和抗菌素应用史、糖尿病史及气管切开时间是主要影响因素，临床上对这些影响因素给予相应的护理对策对预防肺部感染和提高患者的满意度有积极意义。

[关键词]脑外伤；气管切开；肺部感染；护理

[中图分类号] R473.6 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0189-04

Analysis of the factors of pulmonary infection after tracheotomy in patients with traumatic brain injury and the nursing countermeasures

WU Min1 LIU Hui-ling2 XU Xiao-hong3

1.Department of Science and Education， the Second People′s Hospital of Yichun City，Jiangxi Province，Yichun，336000，China；2.Department of Urology Surgery， People′s Hospital of Koan City in Jiangxi Province， Koan， 330800，China；3.Department of the First Pediatrics， People′s Hospital of Koan City in Jiangxi Province， Koan， 330800，China.

[Abstract]Objective To explore the risk factors of pulmonary infection after tracheotomy in patients with traumatic brain injury，and to evaluate the application value of targeted nursing intervention in patients with pulmonary infection.Methods 80 cases of tracheotomy patients with brain trauma admitted to our hospital from February 2015 to May 2017 were selected as the research objects， and the clinical data such as Glasgow（GCS）score，albumin，tracheotomy time，medical history of pulmonary infection patients （n=27） and non-infection patients （n=53） were analyzed and compared emphatically.The targeted nursing intervention was used in the patients with pulmonary infection，and the normal nursing methods were used in non infected patients，to compared the nursing satisfaction of the two groups.Results The results of univariate analysis showed that there were statistically significant differences in smoking history， diabetes history，gastric tube indwelling， combined injuries， prophylactic use of antibiotics， application of hormones，GCS score， tracheotomy time and albumin level between infected and non-infected groups （P<0.05）.Multivariate Logistic regression analysis showed that the independent risk factors of lung infection after tracheotomy in patients with brain trauma were the longer time of tracheotomy， the lower GCS score，the history of hormone use and diabetes mellitus （P<0.05）.There was no statistically significant difference in smoking history， gastric tube indwelling，combined injuries，prophylactic application of antibiotics and albumin levels （P>0.05）.The total satisfaction of patients in the infected group was lower than that in the non-infected group，but there was no significant difference （χ2=0.200，P>0.05）.Conclusion There are many factors affecting pulmonary infection after tracheotomy patients with traumatic brain injury，including hormone and antibiotics application history，diabetes history and tracheotomy time are the main influence factors，the clinical impact of these factors to give corresponding nursing measures for the prevention of pulmonary infection and has a positive significance to improve patient satisfaction.

[Key words]Brain trauma；Tracheotomy；Pulmonary infection；Nursing

脑外伤是神经外科临床中发生率较高的一种危急重症，其临床特点主要为预后情况不理想、致残率和病死率高等[1]。在对脑外伤患者进行抢救时，保持呼吸道畅通是保证患者生命安全的关键措施之一。气管切开能呼吸道畅通的必要手段，能够有效和及时保证患者的呼吸功能，然而却容易导致肺部感染，一旦感染得不到及时有效的控制更直接对对其生命安全造成威胁[2-3]。本……