发生呼吸机相关性肺炎的高危因素及病原菌分析

High Risk Factors and Etiology Character of Ventilator-associated Pneumonia

目的探讨医院内呼吸机相关性肺炎（VAP）发生的高危因素及病原菌感染特征，为临床预防提供指导，推动医院感染的控制工作。方法取我院2005年1～10月ICU住院并行机械通气≥48h患者83例，其中诊断符合VAP的患者37例，未发生VAP46例为对照。结果在VAP患者的气道分泌物中，以革兰阴性杆菌为主（58．0％），其中铜绿假单胞菌为最常见菌（32．0％），其次为不动杆菌属、表皮葡萄球菌等，合并真菌混合感染亦较多（22．0％）；通气天数长、行气管切开、使用皮质激素及患者神志情况等与VAP发生有显著相关性；制酸剂使用与否与VAP的发生差异无显著相关性。结论VAP的发生与多种临床因素有关，对这类因素应尽量控制，以减少VAP的发生。

OBJECTIVE To analyze the high risk factors and etiology character of ventilator-associated pneumonia （VAP） and provide the guidance for preventing VAP. METHODS Eighty three cases given mechanic ventilation over 48 hours in ICU of our hospital from Jan to Oct 2005 were observed. Thirty seven cases met the diagnosis criteria of VAP, while 46 cases without VAP were taken as control. RESULTS Airway secretion was cultivated and Gram-negative germ was the majority（58.0%）. The first three pathogens were Pseudomonas aeruginosa （32.0 %）, Acinetobacter, and Staphylococcus epidermidis, 22.0 % cases had mixed infection with fungi. Except antiacid treatment, the following factors, such as long time for mechanical ventilation, trachea incision, corticosteroids treatment and coma state had significant relationship with the occurrence of VAP. CONCLUSIONS The occurrence of VAP is related with multiple clinical factors. Clinicians should reduce high risk factors to lower the occurrence of VAP.