长期机械通气的老年患者医院内肺部感染的调查

Nosocomial Pulmonary Infection in Elderly Patients with Long-term Mechanical Ventilation

目的 调查和分析长期应用机械通气的老年患者医院内常见的肺部感染.方法 对2002年1月～2005年6月住院期间中长期应用机械通气的69例患者进行回顾性分析;对其中普通肺炎的相关危险因素进行Logistic回归分析.结果 69例患者中发生普通肺炎53例,肺结核7例,结核性胸膜炎1例,非结核分枝杆菌3例,卡氏肺囊虫8例;引发普通肺炎的相关危险因素是应用通气机的时间和误吸.结论 缩短用通气机时间和防止误吸是预防普通细菌性肺炎的重要措施;对长期机械通气的老年患者,还要警惕结核分枝杆菌、非结核分枝杆菌以及卡氏肺囊虫引起的肺部感染.

OBJECTIVE To investigate nosocomial pulmonary infection in elderly patients receiving long-term （at least 30 day） mechanical ventilation. METHODS Retrospective survey was carried out in the aged patients with long-termmechanical ventilation, who admitted from Jan 2002 to Jun 2005. The risk factors of common pneumonia were studied by means of Logistic regression analysis. RESULTS In 69 cases with long-term mechanical ventilation, 53 patients were caught common pneumonia （76. 81%）. Pulmonary tuberculosis and plural tuberculosis were 7 （10. 14 %） and 1 （1.14 %）, respectively. Nontuberculous mycobacterial infection was identified in 3 cases （4. 35% ）. There were 8 cases suffered from Pneumocystis carinii pneumonia（11.59 %）. The length of mechanical ventilation and aspiration seemed to be the important risk factors for the development of common bacterial pneumonia. CONCLUSIONS The most significant preventive measures of common pneumonia include short mechanical ventilation and prevention of aspiration of gastric contents, Mycobacterium tuberculosis, nontuberculous mycobacteria and P. carinii induced pneumonia also should be considered in the elderly with long-term mechanical ventilation.