急诊EICU病房呼吸机相关性肺炎98例流行病学分析

An analysis on 98 Cases Epidemiology of Ventilator Associated Pneumonia in Emergency EICU Ward

目的分析急诊重症监护病房呼吸机相关肺炎(ventilator associated pneumonia简称VAP)的致病菌,探讨VAP的发病机制及预防措施。方法对本院急诊重症监护病房行气管插管或气管切开98例患者为对象,分为感染组和对照组,分析VAP患者的临床资料、病原菌构成。同时抽取两组血清,比较TNF-A、IL-2的浓度值。结果 VAP发生率42.86%。革兰阴性杆菌占81.43%,前3位致病菌分别是铜绿假单胞菌(28.57%)、鲍曼不动杆菌(18.57%)和肺炎克雷伯杆菌(15.71%)。细菌耐药率较高。与对照组相比较,感染组患者的死亡率显著高于对照组。与对照组相比,感染组患者的TNF-Α、IL-1的含量明显上升P(<0.05)。结论重症监护病房VAP的致病菌以革兰阴性杆菌为主且呈多重耐药现象,通过内毒素或外毒素刺激细胞免疫系统,分泌致炎细胞因子,同时激活凝血途径,加重病情。

Objectives This article analyzes pathogenic bacteria of ventilator associated pneumonia（VAP） in ICU ward in emergency department,discussing its pathogenesis and prevention countermeasures to it.Methods 98 patients who had tracheal intubation or tracheotomy in ICU ward in emergency department are separated to infection group and comparison group,analyzing the clinical materials and formation of pathogen.At the mean time,two groups of serum are selected to compare the concentration value of TNF-Α,IL-2.Results The occurrence rate of VAP is 42.86%.Gram-negative bacilli accounts for 81.43%.The top three pathogenic bacteria are respectively pseudomonas aeruginosa（28.57%）,Acinetobacter baumannii（18.57%）,Klebsiella pneumoniae（15.71%）.The tolerance rate of bacteria is highest.Compared to comparison group,the death rate of infection group is obviously higher than it.Compared to comparison group,the contents of TNF-Α,IL-1 in infection group distinctly increase P（0.05）.Conclusions The pathogenic bacteria in ICU ward is mainly gram-negative bacilli with multi-tolerance,through endotoxin or exotoxin stimulating cellular immune system,proinflammatory cytokine secretion and coagulation pathway activation,which exacerbate the disease.