老年机械通气患者呼吸机气路管道细菌分布及相关因素分析

Distribution of bacterial pollution and relative factor analysis in breathing circuit of senile patients with mechanical ventilation

目的研究老年机械通气患者呼吸机气路管道、口咽部及下呼吸道不同时间段、不同部位的致病菌的细菌学情况,以评价气路管道的污染与下呼吸道感染的关系,探讨气路管道更换或消毒的最佳时间。方法对我院干部医疗科38例老年机械通气患者于48、72、96小时送检的437份标本,进行细菌培养、药敏及定量分析。结果262份标本分离出菌株414株,以革兰阴性杆菌为主,占95.65%;革兰阴性杆菌以鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌为主;气路管道污染率与时间同步增长,并与下呼吸道、咽部、气囊上滞留物感染菌具有一致性。结论老年机械通气患者应在48～96小时,依据气路管道的污染情况及时更换循环管路,下呼吸道感染与气路管道污染的细菌具有一致性。

Objective To study the bacteriological data of senile patients with mechanical ventilation in different time and different body parts,so as to evaluate the relationship between breathing circuit pollution and lower respiratory tract infection as well as explore the best time to change or disinfect breathing circuit.Methods Bacterial culture,drug sensitive test and quantitative analysis were carried out in the 437 samples collected from 38 senile patients for 48 hours,72 hours and 96 hours after mechanical ventilation.Bacteriological data were analyzed statistically.Results 414 strains were separated from 262 samples.The most common pathogens were Gram negative bacilli,accounted for 95.65%,especially acinetobacter baumannii,klebsiella pneumoniae and pseudomonas aeruginosa.Incidence of breathing circuit pollution increased correspondingly with time.Pathogens in breathing circuit were similar with those in lower respiratory tract,oropharynx and subglottic secretion.Conclusions Breathing circuit of senile patients with mechanical ventilation should be changed timely according to the degree of pollution from 48 hours to 96 hours.Pathogens of lower respiratory tract infection are similar with those of breathing circuit pollution.