内外科呼吸机相关性肺炎的病原学分析

Analysis of pathogens in ventilator-associated pneumonia

目的分析内外科呼吸机相关性肺炎(VAP)的病原菌差异,为临床治疗提供参考依据。方法经纤维支气管镜(纤支镜)保护性样本毛刷采取下呼吸道标本,对内科疾病基础上的VAP和外科疾病基础上的VAP的细菌培养结果进行了统计分析。结果外科VAP病原菌主要以绿脓假单胞杆菌、金黄色葡萄球菌和肺炎克雷伯菌为主。内科主要以肺炎克雷伯菌、金黄色葡萄球菌、坂琦肠杆菌等细菌为主。结论内外科VAP所涉及的细菌虽有相同的菌种,但分布不同。造成这种现象的因素可能与患者本身免疫功能、肺部条件、人工气道建立方法及住院病区环境不同有关。

[Objective]To analyze the pathogen difference in ventilator-associated pneumonia （VAP） between medical and surgical patients in the intensive care unit and provide the data for the clinic treatment. [Methods] The samples were taken from the low respiratory tracts of the patients with VAP by protected bronehoscopic specimen brush and were cultured by the method of blood plate cultivation. [Results] VAP in surgical patients are often caused by Pseudomonas aeruginosa, staphylococcus aureus and Klebsiella pneumoniae; Klebsiella pneumoniae, Staphylococcus aureus and Enterbacterial Sakazakii, however, are the more common pathogens in medical patients. [Conclusion] Pathogens distribution in the airway of surgical and medical patients were different, although both share the same bacterial strains. The difference may be caused by the different immunity situation and pulmonary condition as well as the methods of arificial airway in the patients with VAP, and the circumstances that the patients hospitalized.