新生儿呼吸机相关性肺炎临床分析

Clinical analysis of neonatal ventilator-associated pneumonia

目的随着现代新生儿医学的发展,机械通气的增加,新生儿呼吸机相关性肺炎（ventilator-associatedpneumonia,VAP）成为NICU倍受关注的话题,本文着重探讨新生儿呼吸机相关性肺炎的发病率、高危因素、病原学特点、耐药性及预防措施,为VAP的防治提供一定的理论依据。方法回顾分析2008年1月～2009年1月我院新生儿重症监护室（NICU）中使用呼吸机机械通气154例危重新生儿临床资料。结果154例进行机械通气的患儿中有57例发生了VAP,发生率为37.0%。通过统计分析发现VAP的发生与早产、低出生体重、插管次数、原发肺部疾病及是否早期大剂量使用丙球密切相关（P〈0.05）。主要病原菌为革兰阴性杆菌,占84.2%,其中以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌最多见,且多为耐药菌。结论VAP的病原以革兰阴性杆菌为主,对美洛培南、亚胺培南、环丙沙星等最为敏感,应该根据细菌培养结果正确合理选择抗生素,才能提高机械通气的效率。

Objective Following with the development of neonatology and mechanical ventilation,the people have pay more attention to ventilator-associated pneumonia（VAP）. We discuss the morbidity, risk factor, etiology characteristics, drug-resistance and prevention of VAP in this study. Methods A retrospective,descriptive study was conducted of all neonatal patients admitted to west China second hospital,sichuan university from January,2008 to January,2009. Results Of the 154 neonates who received mechanical ventilation ,57 patients developed VAP,the morbidity was 37.0%. Satistical analysis showed gestations1 age, low birth weight,intubation frequency, primary lung disease and gamma globulin administration were associated with the development of VAP（ P〈0. 05 ）. The proportion of gram negative bacilli was the highest（ 84. 2% ）. The most common gram-negative organisms were ldebsiella pneumoniae, escherichia coli, pseudomonas aeruginosa, and the drug resistantanee was very high. Conclusion The most common causative bacteria of VAP were gram-negative organisms ,which were highly sensitive to meropenem, imipenem and ciprofloxacin, yet often treatable with more focused antibiotic coverage, which depended on the bacterium identified. So as to improve the efficiency of mechanical ventilation.