重症监护室呼吸机相关性肺炎经验性抗生素的选择和效果观察

The clinical observation of empirical treatment used in the ventilator-associatedpneumonia in intensive care unit

目的探讨经验性抗生素初始治疗VAP的临床疗效。方法将符合诊断标准的VAP患者80例,随机分为观察组(40例)和对照组(40例),观察组由笔者经验性给予初始抗生素治疗;对照组由主管医师自行决定初始药物治疗。结果 80例VAP患者呼吸道分泌物中分离出病原菌共109株,其中革兰阴性杆菌81株,革兰阳性球菌22株,真菌6株,革兰阴性杆菌是VAP的主要致病菌。观察组临床疗效和脱机成功率明显优于对照组(P<0.05);观察组在抗生素使用时间、机械通气时间以及ICU住院时间均明显短于对照组(P<0.05)。结论经验性的选用β-内酰胺类药物联合氨基糖苷和氟喹诺酮类治疗能有效覆盖病原菌,降低耐药性,缩短了VAP患者的通气时间和住院时间,减少了抗生素的使用时间,提高其临床疗效。

Objective To access the clinical efficacy of the initial empirical antibiotic treatment in VAP. Methods 80 eases included with VAP were randomly divided into two groups （40eases） and control group （40cases）, observation group was givenby the initialempiricantibiotie therapy of theauthor, control group- with more choices treatment of the eompetentpbysieian. Results 80 eases ofrespiratory secretionsin patients with VAP pathogens isolated 109 with 81 of Gram-negative baeiUi, 22 of Gram-positive baeiUi, and 6 of fungi, Gram-negative bacilli was the main pathogensof VAP. The clinical efficacy and ventilatorremoved rate of obser- vation group was better than eontrel group （P 〈 0. 05 ）. The antibiotic using time, meehaniealventilationtime and ICU staying time of observation groupwere significantly shorter than control group （ P 〈 0. 05 ）. Conclusion Empirical selection of ^-laetam and aminoglyeoside drugseombincd fluoroquinolone therapy in VAP can effeetlvelyeover thepathogens, redueeresistanee rate, ventilationand hospital staying time, reduce antibiotics using time, improveits clinical efficacy.