重症监护室呼吸机相关性肺炎的临床特点分析

Clinical analysis of the patients with ventilator-associated pneumonia in intensive care unit

目的总结重症监护室呼吸机相关性肺炎(VAP)的临床特点,以指导临床防治呼吸机相关性肺炎。方法回顾性分析312例重症监护室行机械通气患者的临床资料,探讨呼吸机相关性肺炎的感染特点与相关危险因素。结果重症监护室行机械通气患者VAP的发生率为68.59%,革兰阴性菌的构成比为62.93%。大肠埃希菌对β-内酰胺类抗生素最为敏感,敏感度达到100%。G+菌中耐甲氧西林金黄色葡萄球菌有40株,耐药率为61.54%,均对万古霉素敏感,敏感度为100%。32株白色念珠菌中,对氟康唑敏感25株,敏感度78.13%。另外VAP患者组与未发生VAP患者组相比较,二者的年龄、COPD病史、侵入性操作、低蛋白血症、糖皮质激素及抑酸剂使用等均具有统计学差异(P<0.05)。结论 VAP致病菌大部分为革兰阴性菌,且多为混合性感染,病原菌对抗生素的耐药谱也有所改变;年龄、COPD病史、侵入性操作、低蛋白血症、糖皮质激素及抑酸剂的使用是临床上发生VAP的主要危险因素。

Objective To analysis the risk factors and clinical characteristic of the patients with ventilator-associat- ed pneumonia in the intensive care unit. Methods Medical records of the patients with ventilator-associated pneumonia in the intensive care unit were enrolled and retrospectively analyzed. Results The incidence of ventilator-associated pneu- monia was 62.93 %. Gram-negative bacterium was the most common infection （62.93%）. Compare with infection group and uninfected groups, there were statistically significant difference in the age, medical history of COPD, invasive opera- tion , hypoalbuminemia, corticosteroid use and gastric acid secretion inhibitor （GAS1） therapy（P〈0.05）. Conclusion Gram-negative bacterium is the most common infection in the VAP infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe. The age, medical history of COPD, invasive operation, hy- poalbuminemia ,corticosteroid use and gastric acid secretion inhibitor （GASI） therapy are the main risk factors for VAP.