Clinical Analysis Of Hospital Acquired Pneumonia In Critically Ill Patients In Department Of Neurosurgery

BackgroundAfter decades of practice and development,critical care medicine has become an important part of modern medicine.In 2008,the national standard of critical care medicine was established as the two level of clinical medicine.In recent years,with the rapid development of ICU,more than second level national hospitals have been generally established ICU,but the management and technical level of them are still under the primary leve.More than half hospitals still implement semi open management mode,which is lack of professional and technical personnel,technical level needs to be further improved.Neurosurgery patients are accounted for a considerable proportion in the second level hospitals ICU,most of the patients are in critical condition,with a certain degree of consciousness disorder and are often associated with glossoptosis,aspiration,airway blockage,poor cough reflex etc.And incidence of hospital acquired pneumonia(HAP)in these patients is higher.The global reported incidence rate of HAP was 0.5%~10%.In western countries,HAP accounted for the top four hospital infections,of which,the incidence rate of intensive care unit(ICU)was 15%~20%,Patients who received mechanical ventilation were up to 18~60%,Fatality rate was more than half.The incidence of HAP in our country is 3~4 times of international incidence,and HAP is the most important infectious disease in the hospital[1].Pulmonary infection is an important factor that affects the prognosis of critically ill patients in Department of Neurosurgery,not only extend the length of hospital stay,but also increase the cost of hospitalization and cause the waste of medical resources.it is reported that lower respiratory infection is one of the main causes of death of patients in the Department of neurosurgery[2].In order to reduce the incidence of hospital acquired pneumonia in the primary hospital,to improve the treatmenteffect and to improve the prognosis of patients.To study the risk factors and pathogenic bacteria distribution and drug resistance of hospital acquired pneumonia has profound clinical significance to improve the level of diagnosis and treatment of pulmonary infection in critically ill patients in Department of Neurosurgery in local primary hospital.ObjectiveTo explore the risk factors,the characteristics of pathogens and control strategies of HAP patients with severe disease in Department of Neurosurgery,to provide the basis for the prevention and treatment of hospital acquired pneumonia of Neurosurgery patients in the local ICU.MethodsRetrospective analysis was used in analyze the clinical data of 986 Neurosurgery patients(Exclude of community-acquired pneumonia and hospitalization no more than 48hours)admitted to Department of critical care medicine from November 2014 to October2016 in the Yanshi people's Hospital of Henan,statistics the incidence and risk factors of hospital acquired pneumonia,and to the related risk factors,pathogenic detection results were analyzed.ResultsThere were 163 patients with acquired pneumonia in hospital,the incidence rate was16.5%.the common hospital acquired pneumonia risk factors includes: age,smoking,coma,hemiplegia,nausea and vomiting,aspiration,pulmonary contusion,endotracheal intubation,tracheotomy,mechanical ventilation,Analgesia sedation etc.Coma and aspiration were independent risk factors.The common pathogenic bacteria of Hospital acquired pneumonia in early(within 4 days)were Streptococcus pneumoniae and Haemophilus influenzae.In the late period(>4 days),the common pathogens were gram negative bacilli and they were mainly Klebsiella pneumoniae,Bauman Acinetobacter,Pseudomonas aeruginosa,Escherichia coli and Pseudomonas maltophilia.Staphylococcus aureus was the mainpathogen of gram positive bacteria.Drug sensitivity tests display that more Klebsiella pneumoniae and baumannii were Multidrug.ConclusionRestore the patient consciousness as early as possible,prevent aspiration,provide appropriate analgesia and sedation to maintain airway patency and good cough reflex,give reasonable application of antibiotic,implement strict disinfection and isolation measures,combined with pulmonary rehabilitation therapy is an effective means to prevent and control hospital acquired pneumonia in Critically ill patients of the Department of neurosurgery.