ICU患者下呼吸道感染原因分析及预防对策

Causes of lower respiratory tract infections in ICU patients and prevention countermeasures

目的研究ICU患者下呼吸道医院感染的原因及危险因素,制定预防感染对策,为医院控制下呼吸道感染提供有效依据。方法选择2009年1月-2011年12月医院收治的273例ICU患者,对其年龄、侵入性操作、基础疾病、住院时间、镇静剂的使用、呼吸机的应用及病原菌的分布等因素与医院感染进行相关性分析。结果 273例患者发生下呼吸道医院感染106例,感染率为38.83%;106例患者送检痰标本297例次,经细菌学检验共分离出265株病原菌,其中革兰阴性菌206株占77.74%,革兰阳性菌37株占13.96%,真菌22株占8.30%;危险因素为年龄、侵入性操作、基础疾病、住院时间、镇静剂的使用、呼吸机的应用等。结论引起下呼吸道医院感染的病原菌主要为革兰阴性菌、革兰阳性菌,其耐药性严重;加强对ICU的管理及危险因素控制,是预防ICU患者下呼吸道医院感染的有效措施。

OBJECTIVE To study the causes and risk factors for the lower respiratory tract infections in the ICU patients and put forward the infection control measures so as to provide the effective basis for control of the lower respiratory tract infections in the ICU patients.METHODS A total of 273 patients,who were treated in the ICU from Jan 2009 to Dec 2011,were enrolled in the study.The correlation between the incidence of nosocomial infections and the age,invasive operation,underlying diseases,hospitalization duration,use of sedatives,application of ventilator,and the pathogens was analyzed.RESULTS The lower respiratory tract infections occurred in 106 of 273 patients with the infection rate of 38.83%,totally 297 case-times of the 106 patients were submitted with specimen sputum,and a total of 265 strains of pathogens were isolated through the bacteriology test,there were 206（77.74%） strains of gram-negative bacteria,37（13.96%） strains of gram-positive bacteria,and 22（8.30%） strain of fungi.The risk factors were the age,invasive procedures,underlying diseases,hospitalization duration,use of sedatives,and application of ventilator.CONCLUSION The gram-negative bacteria and the gram-positive bacteria are the predominant pathogens causing the lower respiratory tract infection,which are highly drug resistant and are sensitive to cefoperazone,sulbactam,and vancomycin.It is an effective way to prevent the lower respiratory tract infections to strengthen the management of ICU and control the risk factors.