机械通气患者下呼吸道感染和多器官功能衰竭与预后

Lower respiratory tract infection and multiple system organ failure for the prognosis of patients receiving mechanical ventilation

目的探讨机械通气患者下呼吸道感染和多器官功能衰竭（ＭＳＯＦ）与预后的关系。方法将机械通气患者下呼吸道分泌物作细菌培养和耐药试验，并分析医院感染、ＭＳＯＦ和死亡病例。结果本组３０例中有２４例并发下呼吸道感染（８０％）。分离出７２株病原菌，其中Ｇ－杆菌５４株（７５％），尤以铜绿假单胞菌为多（５９％），２４例发生ＭＳＯＦ（８０％），１６例患者死亡（５３．３％）。混合菌感染１３例和单一菌感染组１１例分别有１１例和５例死亡（Ｐ＝０．００４９），未感染组无一例死亡。ＭＳＯＦ组有１６例死亡，单器官功能衰竭组无一例死亡（Ｐ＝０．０７２３）。结论下呼吸道感染和ＭＳＯＦ是机械通气患者死亡的主要因素，而机械通气又加重了呼吸道感染和ＭＳＯＦ。

OBJECTIVE To investigate the relationship of lower respiratory tract infection, multiple system organ failure (MSOF) and prognosis of the patients receiving mechanical ventilation. METHODS The germ cultures of secretion samples obtained from lower respiratory tract were conducted and drug resistance was tested by soeptor semi autotest system. The number of dead patients, patients infected with multiple germs and patients with MSOF were statistically analized. RESULTS In all of the 30 cases, there were 24 (80%) pationts with lower respiniatory tract infection and 24 (80%) patients with MSOF, 16 (53.3%) died. 72 germ strains were separated cut and 54 strains were G bacilli (75%), and 43 strains psoudomonas aeruginoea (59%). There were 11 in 13 cases and 5 in 11 casei died in mixed infection group and one in simple infection group, respectively (P=0.0049). But no patient died in noninfection group, nor in single organ failure group (P=0.0723). CONCLUSION Lower respiratory tract infection and MSOF are very common in patients received mechanical ventilation, and mechanical ventilation may play an important role in the infection and MSOF.