呼吸机相关性肺炎高危因素分析及预防

Analysis and prevention of high risk factors of ventilator-associated pneumonia

目的 :研究呼吸机相关性肺炎的发病率、病死率以及发生呼吸机相关性肺炎的相关因素 ,探讨预防措施 ,减低院内呼吸机相关性肺炎发生率 ,降低病死率。方法 :采用回顾性的分析方法 ,对本院ICU机械通气下并发呼吸机相关性肺炎的病人的临床资料及痰培养结果进行分析 ,并提出应对策略。结果 :15 2例接受人工机械通气的ICU患者中 ,40例发生呼吸机相关性肺炎 ( 2 6.3 % ) ;在机械通气后发生呼吸机相关性肺炎时间最短 3d ,最长 10d ,其中第 5～ 7d内发病占90 .5 %。 40例中死亡 12例 ( 3 0 % )。痰培养主要致病菌为革兰阴性菌 ,其次为真菌。生存组与死亡组对照 ,发现患者年龄、疾病严重程度、合并症 (昏迷、糖尿病 )、免疫力低下是发生呼吸机相关性肺炎的内在因素 ;人工气道管理、机械通气时间、无菌操作技术、抗生素应用是发生呼吸机相关性肺炎的外部因素。结论 :昏迷、机械通气大于 7d、糖尿病、应用免疫抑制剂、抗生素不合理应用致耐药菌产生为呼吸机相关性肺炎高危因素 ;主要致病菌 :不动杆菌、铜绿假单胞菌、大肠埃希氏菌、嗜麦芽窄食单胞菌。

Objective To study the morbility, mortality and risk factors of ventilator-associated pneumonia, determine the prevention and treatment strategies to reduce the morbility and mortality of ventilator-associated pneumonia. Methods The clinical data and pathogen distribution and their resistance to antibiotics of patients in ICU with ventilator-associated pneumonia were analyzed retrospectively. The treatment strategies were established. Results Forty patients with acquired ventilator-associated pneumonia in 152 patients received mechanical ventilation. The time of ventilator-associated pneumonia after mechanical ventilation was from the 3 rd to the 10 th day, 90.5% of which was between the 5 th day and the 7 th day. Twelve among the 40 patients died. The main pathogen of sputum culture was Gram-negative bacteria, followed by fungi. Comparing with the living group and dead group, the age, severity of diseases, complications (such as coma, diabetes), immune deficiency were found the inner factors of ventilator-associated pneumonia, while the management of artificial trachea, the time of mechanical ventilation, the sterile operation and the use of antibiotics were the outer factors. Conclusion Coma, mechanical ventilation for over 7 days, diabetes and immune inhibitive drugs and the drug-fast bacteria caused by the improper use of antibiotic are the high risk factors of ventilator-associated pneumonia. The main pathogen is acinetobacter spp, pseudomonas aeruginosa, E. coli, X. Maltophilia.