| ObjectiveTo understand the relationship between pathogenic bacteria of pulmonary infection and bacteria of digestive tract in patients with tracheotomy,to explore the origin of the pathogenic lung infection,and to provide reference for the prevention and treatment of pulmonary infection in Department of Neurosurgery.Object and MethodsObjectives of study:There are 40 patients with tracheotomy in the Department of Neurosurgery,the First Affiliated Hospital of Chengdu Medical College from July to December 2017.Groups: The patients were numbered according to the order of admission,and the SPSS19.0 software was randomly divided into the open aspiration group and the closed sputum suction group.There were 20 patients in each group.Methods: The specimens of lower respiratory tract secretions,throat swabs,gastric juice and anal swabs were collected to carry out routine bacterial isolation and identification at 48 h,9th day and 16 th day after tracheotomy.Outcome measures:1.The basic conditions of the two groups were compared.2.The incidence of postoperative pulmonary infection between the two groups was compared.3.The occurrence of positive sputum samples between the two groups was compared.4.The detection of bacteria in sputum culture of two groups after operation was compared.5.The correlation between the detection rate of bacteria in sputum culture and the bacteria of digestive tract in two groups of patients were analyzed and compared,respectively.6.The bacteria in sputum culture of patients with pulmonary infection and no-infection were compared.7.The correlation between the detection rate of bacteria in sputum culture and the bacteria of digestive tract in patients with pulmonary infection and no-infection were analyzed and compared,respectively.Statistical methods: Data were collected and made use of Excel form to put in order according to patient number,specimen collection time and location.Data were processed with SPASS19.0.The normal distribution data were described by "MeanąSD".The two groups were compared by independent sample t test.The number of caseswas used to represent the enumeration data,and the two-sample rate was compared using the chi-square test or the Fisher's exact probability method.The correlation between two variables was analyzed by linear correlation regression analysis.The significant levels were taken both sides of ? =0.05.Results1.There was no significant difference in age,gender,history of smoking and COPD among the two groups(P>0.05).2.The incidence of pulmonary infection in the open and closed suction groups was78.95% and 44.44%,respectively,and the difference between the two groups was statistically significant(P < 0.05).3.The positive rates of bacterial culture in the open and closed suction groups was78.95% and 42.59%,respectively,and the difference between the two groups was statistically significant(P < 0.05).4.A total of 37 patients after tracheotomy were involved in the study.A total of 111 samples of sputum specimens were sent for inspection and 76 strains of bacteria were cultivated.The number of bacterial strains(detectable rate)were: 16 strains of Klebsiella pneumoniae(14.41%),14 strains of Pseudomonas aeruginosa(12.61%),14 strains of baumannii(12.61%),8 strains of Escherichia coli(7.21%),6 strains of S.maltophilia(5.41%),5 strains of Staphylococcus aureus(4.50%),4 strains of Proteus phlei(3.60%),4 strains of Staphylococcus epidermidis(3.60%),3 strains of Streptococcus pneumoniae(2.70%),1 strain of enterococci(0.90%),1 strain of Enterobacter cloacae(0.90%),respectively.There were a total of 19 patients in the open suction group.57 samples of sputum specimens were sent for inspection and 51 strains of bacteria were cultured.The number of strains(detectable rate)were: 12 strains of Pseudomonas aeruginosa(21.05%),11 strains of Klebsiella pneumoniae(19.30%),9strains of Acinetobacter baumannii(15.79%),6 strains of Escherichia coli(10.53%),4strains of Stenotrophomonas maltophilia(7.02%),4 strains of Staphylococcus aureus(7.02%),2 strains of Proteus phlei(3.51%),1 strain of Streptococcus pneumoniae(1.75%),1 strain of Enterococci(1.75%),1 strain of Enterobacter cloacae(1.75%),respectively.There were a total of 18 patients in the closed suction group.54 samples of sputum specimens were sent for inspection and 25 strains of bacteria were cultured.Thenumber of strains(detectable rate)were: 5 strains of Klebsiella pneumoniae(9.26%),5strains of Acinetobacter baumannii(9.26%),4 strains of Staphylococcus epidermidis(7.41%),2 strains of Pseudomonas aeruginosa(3.70%),2 strains of E.coli(3.70%),2strains of Streptococcus pneumonia(3.70%),2 strains of Proteus phlei(3.70%),2strains of Stenotrophomonas maltophilia(3.70%),1 strain of Staphylococcus aureus(1.85%),respectively.There was significant difference in the detection of Pseudomonas aeruginosa in sputum culture between the two groups(P<0.05).There were no significant differences in the detection of other bacterias in sputum culture between the two groups(P>0.05).5.The liner correlation regression analysis was used to analyze the correlation between the detection rate of each group of pharyngeal swabs,gastric juice and rectal swab and sputum.The results of the open sucking group were r=0.941 P<0.001,r=0.921P<0.001,and r=0.705 P=0.011,respectively.The results showed that there was a significant correlation between the detection rate of bacteria in throat swab,gastric juice and anal swab in the open suction group(P<0.05 and r>0.6).The results of the closed suction group were r=-0.111 P=0.732,r=-0.003 P=0.993,and r=0.111 P=0.731,respectively,indicating that the correlation between the detection rate of bacteria in throat suction swabs,gastric juice and anal swabs and the detection rate of sputum bacteria was not significant(P>0.05).6.A total of 23 patients with pulmonary infection after tracheotomy were involved in the study.A total of 69 samples of sputum specimens were sent for inspection and 66 strains of bacteria were cultivated.The number of bacterial strains(detectable rate)were:14 strains of Klebsiella pneumoniae(20.29%),13 strains of Pseudomonas aeruginosa(18.84%),13 strains of Acinetobacter baumannii(18.84%),8 strains of Escherichia coli(11.59%),5 strains of Stenotrophomonas maltophilia(7.25%),5 strains of Staphylococcus aureus(7.25%),3 strains of Proteus phlei(4.35%),2 strains of Streptococcus pneumoniae(2.90%),2 strains of Staphylococcus epidermidis(2.90%),1strain of Enterobacter cloacae(1.45%).A total of 14 patients with pulmonary no-infection after tracheotomy were involved in the study.A total of 42 samples of sputum specimens were sent for inspection and 10 strains of bacteria were cultivated.The number of bacterial strains(detected rate)were: 2 strains of Klebsiella pneumoniae(4.76%),2 strains of Staphylococcus epidermidis(4.76%),1 strain of Acinetobacter baumannii(2.38%),1 strain of Pseudomonas aeruginosa(2.38%),1 strain of Streptococcus pneumoniae(2.38%),1 strain of Proteus phlei(2.38%),1 strain of Enterococcus(2.38%),1 strain of Stenotrophomonas maltophilia(2.38%).There were significant differences in the detection of Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,and Escherichia coli in sputum culture of the two types of patients(P<0.05).There were no significant differences in the detection of other bacterias between the two types of patients(P> 0.05).7.The liner correlation regression analysis was used to analyze the correlation between the detection rate of sputum swabs,gastric juice and rectal swabs and sputum.The results of the patients with pulmonary infection were: r=0.851 P<0.001,r=0.872P<0.001,r=0.717 P=0.009,respectively,indicating that the detection rate of bacteria in throat swabs,gastric juice,and anal swabs in patients with pulmonary infection were significantly correlated with the sputum bacteria detection rate(P<0.05 and r>0.6).The results of the patients with pulmonary no-infection were r=-0.111 P=0.732,r=-0.003P=0.993,and r=0.111 P=0.731,respectively,indicating that the correlation between the detection rate of bacteria in throat suction swabs,gastric juice and anal swabs and the detection rate of sputum bacteria in patients without pulmonary infection was not significant(P>0.05).Conclusions1.Compared with the open type of sputum aspiration,the closed type of sputum absorption is more convenient and efficient to improve the nursing work after tracheotomy,and can effectively prevent the pulmonary infection after tracheotomy in the Department of Neurosurgery.2.The sputum culture bacteria of the patients with open aspiration after tracheotomy are highly related to the colonization of the digestive tract.It indicates that the pathogens of lung infection in these patients may come from the digestive tract.In the clinical work,it is necessary to strengthen the nursing of the digestive tract and maintain the stability of the flora,and block the way of invasion to the respiratory tract in the Department of Neurosurgery.3.The correlation between the sputum culture bacteria and the digestive tractcolonization bacteria is not obvious after tracheotomy,which indicates that the closed sputum suction tube could effectively block the way of digestive tract colonizing bacteria invading the respiratory tract,reducing the overall incidence of pulmonary infection.4.The pathogenic bacteria of pulmonary infection after tracheotomy are closely related to the bacteria in the digestive tract.In order to reduce the incidence of pulmonary infection in patients with tracheotomy,we should not only pay attention to the nursing of the postoperative respiratory tract,but also maintain the ecological balance of the microorganism in the digestive tract,and prevent the invasion of the digestive tract bacteria from the lower respiratory tract in the Department of Neurosurgery. |
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