呼吸内科重症监护病房机械通气患者医院感染的特点与管理

Hospital Infection of Patients with Mechanical Ventilation in RICU:Analysis and Management

目的了解呼吸重症监护病房机械通气患者医院感染的特点,探讨预防感染的措施。方法采集呼吸重症监护病房57例发生医院感染患者的痰液标本进行细菌培养和药敏试验,分析并比较机械通气患者与同期非机械通气患者下呼吸道分泌物病原菌菌株的分布情况及两组患者常用抗生素对G-菌的耐药率。结果呼吸重症监护病房57例医院感染患者中,24例机械通气患者感染G-菌株128株、G+菌株26株,33例非机械通气患者感染G-菌株35株、G+菌株16株;铜绿假单胞菌、鲍曼不动杆菌及金黄色葡萄球菌为感染的主要菌种;机械通气组常用抗生素物对G-菌耐药率均显著高于非机械通气组(P<0.05)。结论呼吸重症监护病房中的机械通气患者易发生医院感染,且菌株的耐药率高;护理上应重视病房管理、医务人员管理和相应的消毒隔离措施,尤其加强对机械通气患者的护理,以降低医院感染的发生率。

Objective To study the characteristics of hospital infection of patients with mechanical ventilation in RICU,so as to discuss the measures for prevention of hospital infection. Methods Sputum specimens were collected from 57 patients on mechanical ventilation in RICU of the Nanjing General Hospital, and were used to study the distribution of the pathogenic bacteria in patients with and without mechanical ventilation. Results Twenty-four of the 57 patients were infected with 128 strains of gram-negative bacteria and 26 strains of gram-positive bacteria. Thirty-five strains of gram-negative bacteria and 16 strains of gram-positive bacteria were found in patients with hospital infection without mechanical ventilation. The main bacteria were Pseudomonas Aeruginosa, Acinetobacter baumanii, and Staphylococcus aureus. The resistance rate to commonly used antibiotics in patients receiving mechanical ventilation were obviously higher than that without mechanical ventilation （ P 〈 0. 05）. Conclusion The patients in RICU, especially those with mechanical ventilation, are liable to have hospital infection;it is important to enhance the defection and isolating measures in nursing to reduce the cross-infection.