呼吸机相关性肺炎61例临床分析

The retrospective analysis of 61 patients with ventilator-associated pneumonia

目的分析呼吸机相关性肺炎（VAP）的发病危险因素及治疗转归。方法回顾性分析249例机械通气患者中发生VAP的61例患者资料。结果6I例VAP患者中年龄、APACHEⅡ评分、机械通气时间〉7d、应用制酸药、意识障碍、抗生素联用以及留置胃管等为VAP发生的高危因素；共分离出91株病原菌，其中革兰阴性菌73株（80．2％），革兰阳性菌17株（18．6％），真菌1株（1．2％），存在多重耐药性。均予敏感抗生素治疗，疗程2～6周，39例治愈（63．9％），22例死亡（36．1％）。结论VAP的发生与危险因素密切相关，主要致病菌为革兰阴性菌，存在多重耐药，预后较差。

Objective To retrospectively analyze risk factor and outcome of VAP after treatment. Methods To retrospectively analyze the incidence of VAP in 249 patients accepted mechanical ventilation. Results Logistic regression analysis shew that age, APACHE Ⅱ scores, the time of mechanical ventilation, gastric acid secretion inhibitor therapy,conscious disturbance ,combinations of antibiotics, stomach catheter insertion were associated risk factors for ventilator-associated pneumonia. A total of 91 pathogenic bacterium were identified. G- pathogenic bacterlums accounted for 80. 2% and G＋ pathogenic baeteriums accounted for 18.6% and true fungus accounted for 1.2%. Multidrug resistance was in most pathogenic bacteriums. All patients were treated with sensitive antibiotics and 39 cases were cured（63.9 % ） and 22 cases were dead（ 36. 1% ） after 2-6 weeks treatment. Conclusion Existence of risk factors of VAP are correlated with risk factor and G＂ pathogenic bacteriums are major pathogenic bacteriums and common drug resisitant mieroorganisma lead to bad outcome.