ICU呼吸机相关性肺炎目标性监测分析

Target surveillance of ventilator-associated pneumonia in intensive care unit

目的通过医院感染的目标性监测,分析ICU呼吸机相关性肺炎的病原菌特点及发病危险因素。方法对2010年1-12月入住ICU>48h患者进行医院感染目标性监测,对确诊呼吸机相关性肺炎患者的病原菌进行鉴定和药敏学分析,并单因素分析VAP发生的危险因素。结果共监测患者191例,发生VAP 51例,检出病原菌84株,其中革兰阴性杆菌61株,占72.6%,革兰阳性球菌15株,占17.9%,真菌8株,占9.5%,主要病原菌分别为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌,分别占26.2%、13.1%、9.5%、7.1%;APACHEⅡ评分高、呼吸机使用时间长、昏迷、使用皮质激素、患糖尿病、应用制酸剂及广谱抗菌药物≥3d为VAP发生的危险因素(P<0.01)。结论 ICU医院感染率高,通过目标性监测能够对病原菌与危险因素及时进行分析评价。

OBJECTIVE To analyze the character of pathogen and the risk factor of ventilator-associated pneumonia（VAP）. METHODS From Jan 2010 to Dec 2010,nosocomial infection objective surveillance were monitored and bacterial culture and antibiotics sensitive test among the patients who were in Intensive Care Unit more than 48 h and were diagnosed as ventilator-associated pneumonia（VAP）. RESULTS The risk factors related to VAP were identified and evaluated with Chi-square test,191 cases were selected,51 patient-times with VAP,84 patient-times with pathogen,including Gram negative bacilli 61（72.6%）,Gram positive cocci 15（17.9%）,fungi 8（9.5%）.The most common pathogen were Acinetobacter baumannii,Pseudomonas aeruginos,K.pneumoniae,Staphylococcus aureu,highly APACHEⅡ,a long time mechanical ventilation,coma.The duration of using cortical hormone≥3 days,diabetes,gastric acid secretion inhibitor（GASI） therapy,wide-spectrum antibiotic were the risk factors for VAP（P0.01）,age,calmative,deep vein pipe were insignificant in statistics（P0.05）. CONCLUSION The nosocomial infection rate is highly in ICU.The objective surveillance of nosocomial infection is an effective method.Through the objective surveillance pathogen and the risk factor of VAP can be monitored and evaluated in time.The prevention measures for VAP can reduce the rate of ventilator-associated pneumonia.