[摘要] 目的 探讨小儿重型颅脑损伤患者救治过程中医院感染的临床特点,为医院感染的预防控制和管理提供参考。方法 回顾分析90例小儿重型颅脑损伤患者的临床资料，统计医院感染部位及感染菌株种类的构成，对比观察医院感染组及无医院感染组患者的危险因素。结果 90例小儿重型颅脑损伤患者中继发医院感染36例，感染率为40.00%；感染部位构成的顺位依次为呼吸道、泌尿道和消化道。感染的菌株种类以G-菌和G+菌为主。格拉斯哥昏迷评分（GCS）低、入住ICU时间长、脱水剂应用时间长、开放性损伤、合并多发伤、侵入性操作以及不合理应用抗生素是医院感染的危险因素（P均 ＜ 0.01）。感染组患儿病死率显著高于非感染组（P ＜ 0.05）。结论 小儿重型颅脑损伤患者医院感染发生率较高，感染后可增加患儿致残致死率；GCS、入住ICU时间、脱水剂应用时间及开放性创伤、合并多发伤、侵入性操作、不合理应用抗生素等是医院感染的重要因素，临床应针对感染因素进行积极预防。
[关键词] 小儿重型颅脑损伤；医院感染；危险因素；临床特点
[中图分类号] R726 [文献标识码] A [文章编号] 1674-4721（2012）03（c）-0043-03
An analysis of clinical characteristics of severe traumatic brain injury with nosocomial infection in children
TANG Pingyuan WANG Wenzhang
The Jieshou Orthopedic Hospital of Xing"an County in Guilin City, Guangxi Zhuang Autonomous Region, Xing"an 541306, China
[Abstract ] Objective To investigate the treatment of pediatric patients with severe craniocerebral injury of nosocomial infection in clinical features, for the prevention of nosocomial infection control and management to provide reference. Methods The clinical materials of 90 cases of severe craniocerebral injury in children patients were analyzed retrospectively, the statistical analysis of the nosocomial infection and infection species were performed, and the risk factors of hospital infection in hospital infection group and non-nosocomial infection group were observed. Results Hospital infection was 36 cases, the infection rate was 40.00%; the sites of infection were respiratory tract，urinary tract and gastrointestinal tract. The types of infection species were G- bacterium and G+ bacteria. The risk factors included the low GCS score, the long time in ICU, the dehydrating agent application for a long time, the opened injury complicated with multiple injuries, the invasive operation and the unreasonable application of antibiotics(P ＜ 0.01). The mortality in hospital infection group was ignificantly higher than that in non-nosocomial infection group(P ＜ 0.05). Conclusion The pediatric patients with severe head injury are higher in nosocomial infection, which can increase the disability and death rate. The GCS score, the time in ICU, the dehydrating agent application, the opened injury complicated with multiple injuries, the invasive operation and the unreasonable application of antibiotics are important factors for the nosocomial infection. The prevention should be active performed in accordance with the clinical infection factors.
[Key words] Children with severe traumatic brain injury; Nosocomial infection; Risk factors; Clinical characteristics
重型颅脑损伤病情危急重,在诊治过程中极易合并各种继发感染, 严重影响病情进程及预后，是致残、致死的重要原因之一[1]。为探讨小儿重型颅脑损伤患者医院感染的临床特点及预防措施，笔者回顾性分析本院收治的90例小儿重型颅脑损伤患者的临床资料，报道如下：
1 资料与方法
1.1一般资料
2005年1月～2010 年1月在本院治疗的小儿重型颅脑损伤患者共90例，男68例，女22例，男女比例为3.09∶1，年龄2～13岁，平均（8.65±3.1）岁；跌落伤42例，车祸伤28例，钝器伤13例，其他7例。入院时格拉斯哥昏迷评分（GCS） 3～8 分，平均（6.12±2.14）分。
1.2方法
回顾分析90例小儿重型颅脑损伤患者的临床资料，医院感染诊断标准参照《医院感染诊断标准（试行）》[2]。统计医院感染部位及感染菌株种类的构成，对比观察医院感染组及无医院感染组患者的危险因素。
1.3统计学方法
采用SPSS 13.0统计学软件进行数据处理，计量资料以均数±标准差（x±s）表示，两组比较采用两样本均数t检验，计数资料的比较采用χ2检验，以P ＜ 0.05为差异有统计学意义。
2 结果
2.1 医院感染部位的构成
90例小儿重型颅脑损伤患者中继发医院感染 36 例, 感染率为40.00%；感染部位构成的顺位依次为呼吸道、泌尿道和消化道。见表1。
2.2菌株种类以及构成
分别取自痰液、尿液、脑脊液、血液等标本共计100 份，检出病原菌80株，检出率为80.00%。其中G-菌36株，占45.00%；G+菌31株，占38.75%；真菌13株，占16.25%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌为主；G+菌以金黄色葡萄球菌、肺炎链球菌为主。
2.3医院感染的相关因素
GCS低、入住ICU时间长、脱水剂应用时间长、开放性损伤、合并多发伤、侵入性操作以及不合理应用抗生素是医院感染的危险因素（P均 ＜ 0.01）。见表2。
2.4医院感染的预后
感染组死亡11例，病死率为30.55%（11/36），非感染组死亡6例，病死率为11.11%（6/54），两组病死率比较差异具有统计学意义（χ2=5.330，P