慢性阻塞性肺疾病患者呼吸机相关肺炎的病原菌特点与临床分析

Clinical charateristics and pathogenesis of chronic obstructive pulmonary disease complicated with ventilatorassociated pneumonia

目的探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者呼吸机相关肺炎（ventilator-associated pneumonia，VAP）的病原菌分布与临床特点。方法回顾分析对我院呼吸科及重症监护病房COPD并呼吸衰竭患者行插管机械通气发生VAP的52例患者的下呼吸道分泌物、肺泡灌洗液等标本进行细菌培养和药敏实验，并分析临床特点。结果COPD并VAP的主要病原菌依次是铜绿假单胞菌（25．6％）、肺炎克雷伯菌（15．8％）、耐甲氧西林金黄色葡萄球菌（15．8％）、鲍曼不动杆菌（13．4％）和大肠埃希菌（8．5％），以革兰阴性杆菌为主。结论COPD并VAP病原菌对常见抗生素耐药性较高，机械通气术前抗生素应用者，VAP的病原菌高度耐药，病死率较高；抗生素治疗应用降阶梯方法病死率较低；迟发性（4d后）VAP与早发性（4d内）VAP病死率差异无统计学意义。

Objective To analyze clinical charateristics and pathogenesis of chronic obstructive pulmonary disease（COPD） complicated with ventilator-associated pneumonia（VAP）. Methods To review the clinical characteristics, bacterial culture and antibiotics sensitivity of specimen from tracheal secretion and bronchoalveolar lavage. Fifty-two patients of COPD complicated with VAP after mechanical ventilation in respiratory intensive care unit （RICU） were analyzed. Results Pathogenic bacteria for COPD complicated with VAP were mostly gram negative bacteria including Pseudomonas aeruginosa（25.6%）, Klebsiella spp （15.8%）, Methicillin-resistant Staphylococcus aureus （ 15.8% ）, Acinetobacter baumanii （ 13.4%） and Escherichia coli（8. 5%）. Conclusions High resistance to antibiotics among the above pathogenic bacteria of COPD complicated with VAP, and higher mortality especially therapy with antibiotics before mechanic ventilator are shown. De-cascalation therapy with antibiotics can decrease mortality. The rates of mortality are of no statistical significance between early-onset（in four days） VAP and late-onset（after four days） VAP.