新生儿呼吸机相关性肺炎的病原学和相关因素分析

Etiology and relevant factor of neonatal ventilator-associated pneomania

目的分析新生儿呼吸机相关性肺炎(VAP)的病原学特点和相关因素。方法回顾分析2011年1月～2011年12月淮安市妇幼保健院93例机械通气治疗的新生儿临床资料。按照是否发生VAP,分为VAP组(n=37)和非VAP组(n=56)。比较两组机械通气时间、镇静剂应用时长、再插管情况和住院时间;观察VAP感染菌群情况。结果 93例机械通气患儿中发生VAP 37例,发生率为39.8%;VAP组在孕龄[(35.6±3.9)周]、出生体重[(2.42±0.66)kg]均低于非VAP组[(37.3±3.0)周、(2.72±0.59)kg],两组差异均有统计学意义(均P<0.05);VAP组在机械通气时间[(99.48±33.46)h]、镇静剂应用时长[(58.73±22.54)h]、再插管比例[29.7%(11/37)]和住院时间[(21±8)d]均高于非VAP组[(73.62±15.25)h、(41.16±9.13)h、8.9%(5/56)、(16±7)d],差异均有统计学意义(均P<0.05)。VAP组细菌培养阳性34例,阳性率91.9%,其中G-杆菌15例(44.12%),G+球菌18例(52.94%),真菌1例(2.94%);鲍氏不动杆菌是最常见的革兰阴性菌,缓症链球菌是最常见的革兰阳性菌。结论新生儿VAP感染菌群和相关因素较为复杂,了解其相关因素和主要病原体对于新生儿VAP的防治具有重要意义。

Objective To analyze etiology and relevant factor of ventilator-associated pneomania （VAP）. Methods 93 cases with mechanical ventilation from January 2011 to December 2011 in Maternity and Child Heahhcare Hospital of Huai＇an City were selected and divided into VAP group （n = 37） and non-VAP group （n = 56）. The duration of me- chanical ventilation, sedative application time, reintubation situation and hospital stay time were compared between two groups. Infection flora in the VAP group were observed. Results 37 cases of VAP were found in 93 cases with me- chanical ventilation, the occurrence rate was 39.8%; gestation age, birth weight in VAP group [（35.6±3.9） weeks, （2.42±0.66） kg] were all lower than those in non-VAP group [（37.3±3.0） weeks, （2.72±0.59） kg], the differences were statistically significant （P 〈 0.05）; the duration of mechanical ventilation, sedative application time, reintubation rate, hospital stay time in VAP group [（99.48±33.46） h, （58.73±22.54） h, 29.7% （11/37）, （21_＋8） d] were all higher than those in non-VAP group [（73.62±15.25） h, （41.16±9.13） h, 8.9% （5/56）, （16±7） d], the differences were statistically significant （P 〈 0.05）. 34 cases of positive germiculture were found, positive rate was 91.9%; 15 cases （44.12%） of G- bacillus were found, 18 cases （52.94%） of G＋ cocci were found, 1 case （2.94%） of fungus was found. Acinetobacter baumannii was the most common gram negative bacteria. Streptococcus mitis was the most common gram positive bac- teria. Conclusion Infection flora and related factors of neonatal VAP is more complex, studying the related factors and the main pathogens has positive meaning to the early prevention of neonatal VAP.