54例慢性阻塞性肺疾病患者呼吸机相关性肺炎的临床分析

Clinical Analysis of 54 Cases With Chronic Obstructive Pulmonary Disease Complicated With Ventilator-associated Pneumonia

目的:分析呼吸重症监护病房中慢性阻塞性肺疾病(COPD)患者呼吸机相关性肺炎(VAP)病原学分布特点及相关危险因素。方法:回顾性分析54例行机械通气的COPD患者的临床资料。结果:29例(53.7%)患者发生了VAP,VAP的治愈率为20.7%;好转率为34.5%;死亡13例,病死率为44.8%。未发生VAP的患者为25例,死亡3例,病死率为12%。VAP组的病死率明显高于未发生VAP组(P<0.05)。其中应用广谱抗菌素合用糖皮质激素(≥7d)患者的VAP发生率高达72%明显高于未合用糖皮质激素或合用糖皮质激素≤7d的患者;VAP中最常见的致病菌是G-杆菌(82%),其中铜绿假单胞菌(41%)、肺炎克雷伯氏菌(23%)最常见,其次为大肠埃希氏菌(7%),G+菌以金黄色葡萄球菌、表皮葡萄球菌为主。结论:COPD患者行机械通气VAP的发生率较高,病死率也较高,必须采取综合性的预防措施才能有效控制。明确病原学对经验性治疗有良好的指导意义。

Objective：To analyze the pathogens and risk factors in patients with chronic obstructive pulmonary disease （COPD） complicated with ventilato〉associated pneumonia （VAP） in respiratory intensive care unit （RICU）. Methods： Clinical data of 54 patients with COPD who underwent mechanical ventilation were analyzed retrospectively. Results： VAP oceured in 29 （53. 7%） patients, the cure and improvement rate were 20. 7% and 34. 5% respectively, 13 cases died account for 44. 8% . Among 25 patients without VAP, only 3 died, the mortality was 12%. The mortality was significantly higher in VAP group than that in non-VAP group （P〈0. 05）. The incidence of VAP in patients who had treated with wide spectum antibiotics and glucocorticoid （≥ days） was up to 72%, significantly higher than that in the other groups. The most common pathogens were gram-negative bacilli （82%）. Among them pseudomonas aeruginosa （41%） and klebsiella pneumoniae （23%） were most commonly seen and escherichia coli （7%）was the second. The most common gram-positive bacilli were mainly staphylococcus aureus and staphylococcus epidermidis. Conclusions： The incidence and mortality of VAP are higher in patients undergone mechanical ventilation, preventive measures should be taken to control VAP. Clearly understanding the pathogenic spectrum in COPD with VAP is helpful for empirical therapy.