60例院内获得性肺炎临床分析

Clinical analysis of 60 cases of nosocomal pneumo-nias

对６０例院内获得性肺炎作了床分析。发病时间超过３０天最多，为２７例（４９％）。基础病以血液病为首位１８例（３０％），脑血管病９例（１５％），结缔组织病８例（１３．３％）。常见的诱发因素为应用糖皮质激素和化疗３４例（５６％）、气管切开和插管７例（１１．６％）。９６％病人有发热，６３．３％有咳嗽。痰培养阳性率９５．４５％，细菌以绿脓汗菌２５例（５６．８％）和克雷伯杆菌１８例（４０．９％）为主。药敏试验发现绿脓杆菌对第三代先锋霉素耐药性增加，对环丙氟听酸和多粘菌素Ｂ的敏感性最佳，克雷伯杆菌对多种抗菌素产生耐药，尤其是对氨书和羧节青霉素最明显。绿脓杆菌感染病人死亡率为５８．３３％，克雷伯杆菌感染为６０％，混合感染为６６．６７％。并对院内获得性肺炎的发病情况、发病诱因、细菌耐药性及影响预后因素进行了讨论。

his article gives a clinical analysis upon 60 casesof nosocomial acquired pneumonia. All the patients are>18 years old and the onset time ranged from 3 to 180days after they were hospitalized with an average of38. 77 days , mostly 30 days after admission (27 cases .49% ). Among the primary diseases, the hematologicdisorder (18 cases , 30%) rank the first , followed bycerebrovascular disease (9 cases, 15%) and connectivetissue disease (8 cases , 13. 3 %) . The common induc-ing factors are the using of corticosteroids andchemotherapy (34 cases , 58%) . tracheotoniy and tracheal cannula (7 cases . 11. 6% ). Fever occurs in 96%of the patients and cough 63. 3%. The posrtive rate ofsputum bacterial culture is 95.46%. Pseudomonasaeruginosa isolated in 25 cases (56. 8%) , and Kleb-siella pneumoniae 18 cases (40%). P. aeruginosashows resistant to the third generation of cefalosporinsmore than before , and is sensitive to ciprofloxacin andpolymyxin B, while K. pneumoniae is resistant tomany kinds of antibiotics, especially ampicilline andcarbenicilline. The death rate of infection of P. aerugi-nosa is 58. 33% (14/25) and that of K. pneumoniae is60% (12/18) , that of mixed infection is 66. 67% (16/23 ) .