极低出生体重儿呼吸机相关性肺炎的临床分析

Ventilator-associated pneumonia in extremely low birth weight neonates

目的探讨极低出生体重儿呼吸机相关性肺炎(VAP)的临床特点及预防措施。方法对2008年收住温州医学院附属儿童医院新生儿重症监护病房(NICU)的机械通气≥48 h的62例极低出生体重儿的临床资料进行回顾性分析,并分析下呼吸道痰液标本所分离病原菌的菌种和耐药性。结果 VAP发生率为41.94%;病原菌主要是耐药性条件致病菌,以革兰阴性菌为主,占82.61%,居前3位分别是肺炎克雷伯菌、嗜麦芽寡养单胞菌、鲍氏不动杆菌,分别为30.43%、21.74%、13.04%;革兰阳性菌占17.39%,以缓症链球菌为主,占8.69%;新生儿继发VAP显著增加死亡率(P<0.05)。结论极低出生体重儿呼吸机相关性肺炎病原菌主要是耐药性条件致病菌,以肺炎克雷伯菌为主;继发VAP与否是影响治疗效果及抢救成功率的一个重要因素。

OBJECTIVE To investigate the clinical manifestations of ventilator-associated pneumonia in very low birth weight neonates and its precautions. METHODS A retrospective analysis of the clinical data of 62 cases of very low birth weight neonates, who were admitted into neonatal intensive care unit and treated the intuhated ventilation for ≥48 hours, was performed. RESULTS The incidence of VAP was 41.94%. The main pathogens isolated by tracheal aspiration were opportunistic antibiotics resistant bacteria, and the majority was Gram negative bacilli （82.61%）. The most frequently detected organisms were Klebsiella pneumonia （30.43%）, Stenotroph- omonas maltophilia （21. 74%）, Acinetobacter baumanii （13. 04%）, and Gram positive bacteria accounted for 17.39%, of which the majority was Streptococcus mitis （8.69%）. Sick neonates who complicated with VAP had a significant higher mortality rate （P〈0.05）. CONCLUSION The main pathogens isolated from very low birth weight neonates with VAP are usually the antibiotic resistant opportunistic bacteria. The secondary VAP has an important effect on the mortality and treatment of VLBW newborn.