COPD机械通气并发呼吸机相关肺炎45例临床分析

Clinical analisis of chronic obstructive pulmonary disease complicated with ventilator-associated pneumonia in 45 patients

目的分析慢性阻塞性肺病(COPD)有创机械通气并发呼吸机相关肺炎(VAP)的相关因素及致病菌。方法回顾性分析近年来本院ICU收治的45例COPD机械通气并发VAP患者的临床资料、发病原因和致病菌。结果VAP的发生率为73.7%,共培养出细菌73株,真菌3株;其中革兰氏阴性杆菌(GNB)50株(68.49%),革兰氏阳性球菌(GPC)20株(27.39%)。COPD并发VAP居首位的细菌是铜绿假单胞。结论VAP是COPD有创机械通气治疗中常见的严重并发症,应尽早停机拔管,改用无创通气,合理使用抗生素,谨慎使用抗酸药,注意无菌操作,是预防VAP的有效措施。

Objective To analyze the correlation factors and pathogenic bacterium of ventilation - associated pneumonia （VAP） coincidened in the invasive ventilated COPD patients. Methods Clinical data of 45 invasive ventilated COPD patients admitted in the ICU of our hospital were retrospectively analyzed. Results The incidence of VAP was 73, 7%. 73 strains bacteria and 3 fungi were cultured from the specimens of these patients. Among them 50 strains were gram-negative bacillus （68.49%） and 20 strains were gram-positive coccus （27.39 % ）. Pseudomonas aeruginosa was the most common pathogenic bacterium in the VAP coincidenced with invasive venti- lated COPD patients. Conclusion VAP is a common and severe complication in invasive ventilated COPD patients, Invasive ventilation should be used cautiously and stoped in use if needed. In such situation, non-invasivc ventilation can be used instead. Other effective mearsures of preventing VAP included rational use of the antibiotics and of antiacids and use of sterile operations.