COPD机械通气并发呼吸机相关肺炎的综合分析

Clinical analysis of chronic obstructive pulmonary disease complicated with ventilator-associated pneumonia after mechanical ventilation

目的 :分析慢性阻塞性肺病 (COPD)患者机械通气治疗后并发呼吸机相关肺炎 (VAP)的危险因素、发病特点和病原菌分布特点。方法 :采用回顾性研究方法 ,对 12 2例COPD并发呼吸衰竭行机械通气治疗的患者 ,根据是否并发VAP分为感染组和未感染组 ,分析其临床特点、病原菌分布及药敏特点等。结果 :COPD并发VAP常缺乏典型的临床表现 ,感染病原菌以革兰氏阴性菌为主 ,混合细菌感染以及合并真菌感染占较高比例 ,感染细菌对多种抗生素耐药。VAP的发生率为 5 5 .8% ,营养状况、合并症、机械通气时间抗生素应用时间、应用糖皮质激素等因素与VAP的发生有关。结论 :COPD并发VAP常缺乏典型的临床表现 ,VAP的发生与多种因素有关 ,感染病原菌复杂、耐药率高、耐药谱广。通过综合防治措施有助于预防和治疗VAP。

Objective:To analyze the risk factors,clinical characteristics and pathogenesis in chronic obstructive pulmonary disease(COPD) complicated with ventilator-associated pneumonia(VAP) after mechanical ventilation.Methods:Retrospective analysis was performed on 122 cases of COPD complicated with VAP after mechanical ventilation for the clinical characteristics,bacterial culture and antibiotics sensitivity.These cases were divided into two groups with or without VAP.Results:The patient with COPD complicated with VAP often had no typical clinical presentation.Etiological microorganisms were predominated by Gram-negative bacterium.Mixed infections were common.Bacteria were often resistant to varieties of antibiotics.The incidence of VAP was 55.8%.Nutrition,complication,duration of mechanical ventilation,duration of antibiotics and steroid were related to the development of VAP.Conclusion:COPD complicated with VAP often has no typical clinical presentation.Development of VAP is associated with multiple predisposing factors.Etiological microorganisms are complex and often resistant to varieties of antibiotics.The combination of multidiscinplary therapy is necessary for prophylaxis and treatment of VAP.