新生儿机械通气相关性肺炎的临床分析

Clinic Analysis of Neonates with Ventilator-associated Pneumonia

目的 :了解新生儿呼吸机相关性肺炎 (ventilator-associatedpneumonia ,VAP)的发病、危险因素、病原学情况及对转归的影响。方法 :首都儿科研究所ICU病房近 2年来行机械通气治疗的新生儿 80例 ,机械通气 (machinicalventilation ,MV)≥ 4 8h者 4 9例 ,其中患VAP2 8例为研究组 ,同期机械通气未患VAP者 2 1例为对照组 ,两组针对VAP的危险因素及VAP对转归的影响进行统计学分析 ;同时对VAP患儿的呼吸道分泌物的实验室结果进行总结。结果 :MV≥ 4 8h者 4 9例 ,患VAP2 8例 ,发病率 5 7%。MV时间是VAP的危险因素 ,VAP对患儿预后有不利影响。VAP的主要病原菌为革兰阴性杆菌。结论 :延长MV时间增加了VAP的发生机率 ,且VAP对预后造成不利影响 ;VAP的病原菌以革兰阴性杆菌为首位 。

Objective:To study the mortality, predisposing factors and the pathogens of VAP in neonates, and to find out the influence on the patient's prognosis. Methods:There were eighty neonates with MV in ICU of our hospital during the last two years and forty-night cases were treated by MV more than 48 hours.Twenty-eight cases of VAP were assigned as an infectious group,and the other twenty-one cases of non-VAP as control group.The predisposing factors of VAP and influence on the patient's prognosis were analysed by statistical methods. Meanwhile,the laboratory result were summaried from the airway secretion of VAP patients. Results:Twenty-eight cases with VAP were diagnosed,the morbidity is 57%.Increasing the time of MV was the risk factor to VAP. VAP had much affection on the patients'prognosis.The predominant pathogen was gram negative bacillus. Conclusion:Long time of MV increased probability of VAP,and VAP had more affection on the patients'prognosis. Gram negative bacillus was the predominant pathogen and had high drug resistance to antibiotics.