呼吸机相关性肺炎的危险因素及病原学研究

Research on Risk Factors and Pathogenic Characteristics of Ventilator-associated Pneumonia

目的:探讨呼吸机相关性肺炎(VAP)的危险因素及病原学特点,以指导临床治疗。方法:回顾性收集机械通气治疗时间>48h的106例患者的病历资料,分析VAP的危险因素、病原菌及耐药性。结果:106例患者中VAP患者共48例(45.3%)。糖尿病、气管切开患者VAP的发病率增高(P<0.05);VAP组病死率明显高于无VAP组(P<0.05);VAP病原菌以革兰阴性菌为主(67.1%),其中以铜绿假单胞菌为主要致病菌(21.9%),绝大多数病原菌出现严重耐药。结论:多种临床因素与VAP的发病有关;VAP病原菌以革兰阴性菌为主,耐药率高;VAP的发生将严重影响患者的预后。

Objective： To evaluate the risk factors and pathogenic characteristics of ventilator-associated pneu monia （VAP） in order to guide the clinical treatments. Methods.. Risk factors of VAP, pathogens and drug resistance in 106 patients treated with mechanical ventilation over 48 hours were analyzed retrospectively. Results： Among 106 cases, 48 （45.3%） cases developed VAP. The incidence of VAP was obviously higher in patients with diabetes and tracheotomy （P〈0. 05）, and the mortality was higher in patients with VAP than those without VAP among 106 cases （P〈0. 05）. The main pathogens of VAP were gram negative bacteria （67. 1%）, and pseudomonas aeruginosa was the major pathogen （21.9%）. Drug resistance was observed in most cases. Conclusions： The occurrence of VAP is related with multiple clinical factors. The gram-negative bacteria are the major pathogens of VAP, drug resistance is common. The occurrence of VAP can severely affect patients＇ prognosis.