呼吸机相关肺炎(附54例临床分析)

Clinic analysis of ventilator-associated pneumonia in 54 patients

目的探讨医院ICU内发生呼吸机相关肺炎(VAP)的临床病原学特点和治疗效果。方法对我院54例VAP患者在病原学检查、细菌对抗生素耐药以及治疗等方面作一回顾性分析。结果54例VAP患者细菌培养均获阳性结果,其中各类细菌混合感染者37例(17例死亡,病死率45.9%),单一细菌感染者17例(5例死亡,病死率29.4%)。共分离出78株细菌,其中G-杆菌51株(65.4%),G+球菌16株(20.5%),真菌11株(14.1%)。其中主要G-杆菌对多种抗生素耐药。治愈或好转32例,死亡22例,死亡率40.7%。结论G-杆菌感染为主,混合感染,对多种抗生素耐药是VAP的临床病原学特点。在获得下呼吸道分泌物标本培养结果之前,采取最初经验性抗菌治疗的“猛击”策略可改善预后。在面对细菌耐药率上升时,采用抗生素干预策略可有效减少耐药。

Objective To disus the clinical pathogenic characteristic and therapy of ventilator associated pneumonia （VAP） in ICU. Methods The data of 54 patients in our hospital with VAP, including bacteria cansing, drug resistance of bacteria and treatment effect, were analyzed retrospectively. Results All of 54 Patients obtained the positive infection evidences, among which mixed infection group aecout for 37 cases and simple infection group accout for 17 cases. 78 bacterial strain were obtained from lower respiratory tract sputum sampies in all 54 patients. Of them 51 strains were Gram-negative bacilli, 16 strains were Gram-postive cocci, 11 strains were mycotic. Most of Gram-negative bacilli were resistant to multiple antibiotics. 32 cases were cured or straighten up. 22 cases died. Death rates were 40.7%. Conclusions Gram-negative bacilli infection, mixed infection and muhi-antibioties resistance are the clinical pathogenic characteristics of VAP. The prognosis can be ameliorated by “hitting hard” strategy with empiric antibiotic treatment before the cultural results of samples from lower respirotory tract are gained.