呼吸机相关性肺炎临床与病原菌特点分析

Ventilator-associated Pneumonia and Pathogens:Clinical Characteristics

目的进一步了解机械通气患者发生呼吸机相关性肺炎(VAP)的临床相关因素和病原菌特点,探讨防治VAP措施。方法对全院机械通气的患者,从使用呼吸机之日起,进行主动的目标性监测。结果全年我院机械通气患者202例,发生VAP者56例、78例次,呼吸机日(VDs)发病率为98例次/1 000 VDs,年龄>60岁、昏迷、气管切开、使用制酸剂、机械通气时间长等,均是发生VAP的重要因素;VAP的病原菌以G-杆菌为多数,占64.8%,其中铜绿假单胞菌居首位占22.7%;真菌占20.5%;混合感染者13例(23.2%);G-杆菌对常用抗菌药物的耐药率较高,分离出的葡萄球菌均为MRS。结论VAP的病原菌以G-杆菌占优势,其次是真菌,病原菌的耐药率较高;尽可能缩短机械通气时间、合理选用抗菌药物、加强消毒隔离措施等,有助于VAP的防治。

OBJECTIVE To study the characteristics of pathogens and risk factors of ventilator-associated pneumonia （VAP） in our hospital to determine the prevention and treatment strategies. METHODS Prospective observation was performed in all the ventilator-related patients in 2004. RESULTS Seventy eight events of ventilator-related pneumonia among 56 cases occurred from all the 202 ventilator-related patients, the infection incidence was 98/1000VDs. The revealed important risk factors were oldness, coma, tracheotomy, use of H-2 receptor inhibitors, and prolonged mechanical ventilation. 64.8% of the pathogens were G^- bacilli, among which Pseudomonas aeruginosa contributed majority accounting for 22.7%, fungi accounting for 20.5%. There was wide resistance to antibiotics in G^＋ pathogens, including all of the isolated Staphylococcus. CONCLUSIONS VAP is caused predominantly by G^- bacteria, fungi, and multiple predisposing factors. The combined treatment is necessary for control of VAP.