院内获得性肺炎36例临床分析

Clinical analysis of 36 cases of nosocomial pneumonia

目的：对36例院内获得性肺炎作临床分析。方法：观察发病时间超过20天13例（50％）；基础疾病中心肺功能不全者17例（47．2％），肿瘤为5例（13．9％），脑血管病4例（11．1％）；血液病2例（5．6％）；常见诱发因素中应用糖皮质激素和化疗10例（27．7％）；气管切开插管4例（11．1％）。90％的病人有发热；50％的病人咳嗽、憋气或者在原有咳嗽的基础疾病基础上症状加重，痰培养阳性率80％；已绿脓杆菌为首位13例（36％），克雷伯杆菌11例（30．5％）。药物敏感试验发现绿脓杆菌对第三代先锋霉素耐药性增加，对环丙氟哌酸和碳青霉烯类敏感性最佳。克雷白菌对多种抗生素产生耐药性增加，尤其是对氨苄和抗酸青霉素类最明显。绿脓杆菌感染的病人死亡率为29％；克雷白菌感染为32％；混合感染为34％。结论：院内获得性肺炎（NP）在院内感染中发病率占首位，多有严重的基础疾病和诱因。死亡率达33．3％，而且细菌耐药菌株多，治疗困难。

Objective： To make analysis of 36 cases of nosocomial pneumonia. Methods： To observe the time of incidence over 20 days for 13 cases （50%）. Patients with pulmonary insufficiency for 17 cases （47.2%）, with cancer for 5 cases （13.9%）, with cerebrovascular disease for 4cases （11.1%）, blood disease for 2 cases （5.6%）. In the common predisposing factors, 10 cases （27.2%） were applied on glueoe -orticoid and chemotherapy, tracheotomy Intubation for 4 cases （11.1%）. 90% of patients got a fever, 50% of patients cough, felt suffocated or symptoms got worse, positive rate of sputum culture was 80%, pseudornonas aeruginosa B at first for 13 cases （36%）, Klebsiella bacillus was 11 cases （30.5%）. Drug sensitivity test found there was an increase in drug resistance between pseudomonas aeruginosa and third-gene -ration Pioneer CTC, especially to Ampicillin and Acid penicillin. Mortality rate of patients infected with pseudomonas aeruginosa Was 29%, Klebsiella Bacteria for 32%, mixed infection for 34%. Conclusion： NP occupied the first place of nosocomial infection, serious underlying diseases and incentives generally. The death rate was 33.3%, had a large number of resistant strains of bacteria, and difficult to be cured.