儿科重症监护室机械通气患儿下呼吸道与呼吸机管路细菌定植规律的监测及分析

Monitoring and analysis of bacterial colonization in lower respiratory tract and ventilator tubing in patients with mechanical ventilation in pediatric intensive care unit

目的:调查分析儿科重症监护室(pediatric intensive care unit,PICU)机械通气(mechanical ventilation,MV)患儿下呼吸道与呼吸机管路细菌定植规律及呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原学特点,为VAP的预防和呼吸机管路的科学管理提供依据。方法:目标性监测PICU接受MV治疗的患儿第4天和第7天VAP发生情况,分析其下呼吸道和呼吸机管路的细菌定植规律及与MV时间的关系。结果:MV第4天组和第7天组在VAP发生率(P<0.05)、Y型接口处和冷凝水的细菌培养阳性率及菌落数(P<0.05)、下呼吸道和呼吸机管路细菌培养的一致性比较差异有统计学意义(P<0.05)。阴沟肠杆菌、鲍曼不动杆菌和白色假丝酵母菌(39.2%)为导致VAP的主要菌群,阴沟肠杆菌、鲍曼不动杆菌和肺炎克雷伯氏菌(47.3%)为呼吸机管路的最主要定植菌群。结论:VAP的病原学与呼吸机管路细菌定植密切相关,MV时间和细菌定植规律影响VAP的发生。尽早脱机、关注Y型接口处的细菌污染、规范化管理冷凝水以及有效控制呼吸机管路的细菌定植对临床预防VAP有重要意义。

Objective：To investigate bacterial colonization regularity in lower respiratory tract and ventilator tubing in patients with mechanical ventilation（MV）and etiology of ventilator-associated pneumonia（VAP）in the pediatric intensive care unit（PICU）and to provide empirical basis for the prevention of VAP and ventilator tubing management.Methods：Incidences of VAP in ventilated patients in PICU or 4 th d and 7 th d were monitored targeted.Bacterial colonization of the lower respiratory tract and ventilator tubing and their relationship with MV replacement time were analyzed.Results：There were significantly differences in VAP incidences（P 0.05）,positive bacterial culture rate and number of colonies in condensate and Y interface（P〈0.05）as well as in consistency of positive bacterial culture of lower respiratory tract and ventilator tubing（P〈0.05）between the 4 th d group and the 7 th day group.Sewer enterobacter,acinetobacter baumannii and white candida mycoderma bacteria（39.2%）were key infection flora leading to VAP while acinetobacter baumannii,klebsiella pneumoniae burt＇s bacteria and sewer enterobacter（47.3%）were primary infection flora colonization in the ventilator tubing.Conclusions：Etiology of VAP is closely related with bacterial colonization in ventilator tubing.Tubing replacement time of MV and bacteria colonization regularity affect incidence of VAP.Off-ventilation as soon as possible,attention to the bacterial contamination at the Y-type interface,standardized management of condensate and effective control of the ventilator tubing bacterial colonization are important to the clinical treatment of VAP and ventilator tubing management.