重症监护室呼吸机相关性肺炎120例临床分析

Clinical analysis on 120 cases with ventilator-associated pneumonia in an intensive care unit

目的了解重症监护室(ICU)机械通气患者呼吸机相关性肺炎(VAP)的临床特点及相关危险因素。方法回顾性分析2007年5月-2009年5月入住某院ICU行机械通气发生VAP患者的临床资料及呼吸道分泌物细菌培养结果。结果 120例VAP患者病原学检查均获得阳性结果,共分离263株病原菌,其中革兰阴性(G^-)杆菌占58.56%,革兰阳性(G^+)球菌占25.09%,真菌占16.35%;铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌和光滑假丝酵母菌是VAP的主要病原菌。2种及以上病原菌混合感染的患者95例(79.17%)。病原菌对抗菌药物的耐药率较高。机械通气时间越长,VAP发生率越高(P<0.05);呼吸机管路消毒更换不及时、留置胃管均可使VAP发生率显著增高(P<0.001)。结论 VAP的主要病原菌为G^-杆菌,混合感染率高,耐药性不断增加,对机械通气患者应针对危险因素进行全面预防,加强监护。

Objective To realize the clinical data and related risk factors of ventilator--associated pneumonia （VAP） in patients in an intensive care unit （ICU） . Methods Clinical data and bacterial culture results of secretion in respiratory tract of patients with VAP in ICU from May 2007 to May 2009 were retrospectively analyzed. Results A total of 263 strains of pathogens were isolated from 120 patients, gram negative bacilli, gram-positive cocci, and fungi accounted for 58.56%, 25. 09% and 16.35% respectively. The main pathogens of VAP included Pseudo- monas aeruginosa , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii and Candida glabra- ta. Ninety-five cases（79.17%） had infections with at least 2 kinds of pathogens. Pathogens had high resistance to antimicrobial agents. The increase of the incidence of VAP was associated with the long duration of ventilation （P〈 0. 05）, as well as delayed disinfection and change in ventilators canalis, and indwelling nasogastric intubation （P〈 0. 001 ）. Conclusion The main pathogens in VAP is gram-negative bacilli, mixed infection is high, and antimicrobial resistance is increasing. Patients with mechanical ventilation should be given comprehensive prevention and intensive care.