肺心病并肺结核患者医院获得性金葡菌肺炎发生及预后分析

Retrospective analysis of hospital acquired pneumonia caused by staphylococcus aureus in pneumocardial disease complicated with pulmonary tuberculosis

目的:探讨肺源性心脏病(肺心病)并肺结核患者医院获得性金黄色葡萄球菌(金葡菌)肺炎发生的危险因素、临床特点及预后。方法:对我院2002年4月￣2007年2月27例肺心病并肺结核患者医院获得性金葡菌肺炎患者临床资料进行回顾分析。结果:肺心病并肺结核患者医院获得性金葡菌肺炎以耐甲氧西林金葡菌(MRSA)感染为主(81.5%);免疫功能低下、病程长、营养状况低下、高龄、入住ICU是高危因素;万古霉素是目前治疗其最有效的药物。结论:积极改善患者的通气功能和抗结核治疗、进行病原学监测、及时发现病例、隔离和治疗患者、合理使用广谱抗生素、严格消毒隔离是控制肺心病并肺结核患者金葡菌感染的主要手段。

Objective：To investigate the clinical features and risk factors about hospital acquired pneumonia caused by staphylococcus aureus in pneumocardial disease complicated with pulmonary tuberculosis. Methods：The hospital acquired pneumonia caused by Staphylococcus aureus in pneumoeardial disease complicated with pulmonary tuberculosis from April 2002 to February 2007 were retrospectively analysed.Results：Hospital acquired pneumonia was mainly caused by MRSA （81.5%）.The important independent risk factors were primary serious disease and long＇term hospitalization in ICU.Iatrogenic factors played an important role in MRSA infection. Vancomycin remained the most sensitive antibiotic for MRSA. Conclusion：The strategy to control MRSA infection is breaking the iatrogenic pathway.Monitoring etiology and isolating the patients infected by MRSA and using antibiotics reasonably and sterilizing strictly are effective measures.