呼吸机相关性肺炎31例病原学分析

ANALYSIS OF CLINICAL CHARACTERISTICS AND ETIOLOGY IN CASES WITH VENTILATOR-ASSOCIATED PNEUMONIA

目的探讨进行机械通气后呼吸机相关性肺炎(VAP)的临床特点及病原学分析,以寻找更好的防治对策,减少病死率,提高抢救成功率。方法对2002年12月—2004年12月进行机械通气发生VAP的31例患者临床资料进行回顾性分析。结果机械通气患者56例,发生VAP31例,发生率为55.4%,发生VAP平均时间(7.2±3.9)d。经鼻插管VAP发生率为70.8%,置管≥6dVAP发生为75.0%,单一高危因素者病死率11.1%,3个或以上高危因素者病死率60.0%,首位致病菌为铜绿假单胞菌(26.3%),G-杆菌对第二、三代头孢菌素、氨基糖甙类、喹诺酮类抗生素较敏感,G+球菌则对多种抗生素敏感性不高。结论缩短机械通气时间,选择合适人工气道留置方式,可减少高危因素且减少VAP的发生,根据药敏结果选用敏感抗生素对VAP治疗有重要意义。

Objective To investigate clinical characteristics and etiology of ventilation-associated pneumonia （VAP）, in order to find the strategy to reduce mortality and improve the prognosis. Methods 56 cases with mechanical ventilation were retrospectively analyzed about the occurrence of VAP from Dec 2002 to Dec 2004. Results Of the 56 cases with mechanical ventilation, 31 cases were diagnosed as VAP（55.4%）. Mean time for the occurrence of VAP was （7.2±3.9） days. Of which, 70.8% of the VAP cases were intubated via nose, 75.0% of the VAP occured more than six days of ventilation. The mortality was 11.1% in patients with single risk factor, 60.0% with more than three risk factors, The main pathogens were Pseudomonas aeruginosa（26.3%）. Gram-negative bacilli were sensitive to second and third-generation of cephalosporins, aminoglycosides, quinupristin antimicrobials; while, gram-positive cocci were resistant to majority of the antibiotics. Conclusion Reducing the duration of intuhation and proper airway may contribute to decreasing of risk factors and incidence of VAP. Antibiotic treatment based on antibiotic sensitive experiment was important in the management of VAP.