呼吸机相关肺炎的危险因素和病原菌临床研究

The study of risk factors and pathogens in ventilator-associated peneumonia

目的探讨呼吸机相关肺炎(VAP)的发病危险因素及其病原学。方法回顾性分析机械通气48小时以上,符合VAP诊断的79例患者的临床资料,对VAP相关因素、致病菌及其耐药性进行统计分析。结果1.APACHEⅡ评分≥15分、持续使用呼吸机≥6天、营养支持低下、应用制酸剂≥3天是VAP独立发病危险因素。2.VAP病原菌以革兰阴性菌为主,占72.04%;居前6位的病原菌依次为铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和真菌,大部分致病菌对青霉素类、头孢菌素等多种抗生素具有较高的耐药性。结论VAP发生率高,应避免危险因素或针对危险因素重点监控,并应根据病原学及药敏结果合理用药。

Objective To investigate the risk factors,pathogens and drug resistance in ventilator - associated pneumonia （VAP）. Methods The influence factors in VAP were retrospectively analyzed. Culture indepof bacteria and drug sensitivity tests were performed for the lower airway secretion of the 23 VAP patients. Results 1. The score of APACHE Ⅱ ≥ 15 ,the duration of mechanical ventilation ≥6 days,lower proportion of proper nutrition support, the using time of antacid ≥ 3 days were the risk factors in VAP. 2.93 strains of pathogens had been obtained by culture, most of which were Gram negative bacilli （ 72.04% ）. Pseudomonas aeruginosa （ PA ）, acinetohacter hauamnnii （ AB ）, Escherichia coli （ E. coli ）, Klehsiella pneumoniae （ KP ）, staphylococcus aureus（SA） ,epiphyte were the chief pathogens of VAP and most of them highly resist to many kinds of antibiotics such as Penicillin and Cephalosporin. Conclusion The incidence of VAP is high, so the risk factors of VAP should be avoid or key - monitored and the choice of antibiotics should he according to the pathogens and drug sensitivity test.