新生儿呼吸机相关性肺炎的临床分析

Clinical Analysis of Neonatal Ventilator Associated Pneumonla

目的探讨新生儿呼吸机相关性肺炎(VAP)的发病率、高危因素、病原学特点、药敏情况及预防措施。方法回顾性分析2009年1月至2013年1月本院新生儿重症监护室(NICU)中采用机械通气(MV)治疗的84例危重新生儿的临床病历资料。按照本组新生儿是否合并VAP,将其分为VAP组(n=34)与非VAP组(n=50)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。两组新生儿的分娩方式、接受MV治疗时日龄(10min～25d)等比较,差异无统计学意义(P>0.05)。结果本组MV患儿的VAP发生率为40.5%(34/84)。VAP发生与早产、低出生体重、MV持续治疗时间、气管插管次数、原发性肺部疾患、是否早期使用静脉注射用人免疫球蛋白(IVIG)及是否早期使用肺表面活性物质等密切相关(r=0.412,r=0.331,r=0.115,r=0.561,r=0.398,r=0.412,r=0.158;P<0.05);与患儿性别无相关性(r=1.235,P>0.05)。本组导致VAP的病原菌以革兰阴性杆菌为主,占79.4%,其中以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌及鲍曼不动杆菌最多见,且多为耐药菌。结论新生儿采用MV持续治疗导致的VAP发病率较高。VAP与MV持续治疗时间,患儿出生体重、胎龄、原发性肺部疾患、气管插管次数、是否早期使用IVIG及是否早期使用肺表面活性物质等多种因素有关。对VAP应采用综合预防措施。根据药敏试验结果合理选择抗菌药物,可提高治疗VAP的成功率。

Objective To study the pathogenesis rate of neonatal ventilator associated pneumonia （VAP）, risk factors, etiology, drug sensitivity and preventive measures. Methods A retrospective analysis of January 2009 to January 2013 in our hospital neonatal intensive care unit （NICU） with mechanical ventilation （MV） treatment of 84 cases neonatal clinical data. According to complicating with VAP or not, they were divided into VAP group （n= 34） and non VAP group （n= 50）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Dujianyan Prople＇s Hospital. Informed consent was obtained from the parents of each participating neonate. There had no significance difference between two groups among mode of delivery, day age（10 min-25 d） by MV continuous treatment （P〉 0.05）. Results VAP incidence was 40.5% in this study. The occurrence of VAP had closely related with premature birth, low birth weight, duration of MV continuous treatment, intubation times, primary pulmonary disease, whether or not early use of human immunoglobulin for intravenous injection （IVIG） and early use of pulmonary surfactant （r=0.412, r=0.331, r=0. 115, r=0.561, r=0.398, r=0.412,r= 0. 158; P〈0. 05）; and had no correlation with gender of neonates （r= 1. 235, P〉0. 05）. Pathogenic bacterias in VAP group were Gram-negative bacilli, accounting for 79. 4%, among them Klebsiella pneumoniae , Pseudomonas aeruginosa , Escherichia coli , Acinetobacter were most common, and they were more for drug-resistant bacterias. Conclusions The longer duration of MV continuous treatment,the higher incidence of VAP. Prevention of VAP basically should adopt comprehensive prevention measures. The pathogenic bacteria causing VAP mainly Gram-negative bacterias. Reasonable selection of antimicrobial agents can improve the success rates of VAP treatment.