NICU患者呼吸机相关性肺炎临床特征分析

Clinical characteristics of NICU patients complicated with ventilator-associated pneumonia

目的探讨神经内科重症监护病房(NICU)合并呼吸机相关性肺炎临床特征及预防措施,为临床诊治提供参考。方法回顾性分析80例NICU应用呼吸机患者的临床资料,观察呼吸机相关性肺炎患者痰培养结果、危险因素及对预后的影响。结果应用呼吸机支持治疗患者共80例,其中发生呼吸机相关性肺炎30例,呼吸机相关性肺炎发生率为37.50%;30例患者检出82株病原菌,其中革兰阴性菌56株占68.29%,革兰阳性菌16株占19.51%,真菌10株占12.20%,前5位病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍氏不动杆菌、假丝酵母菌属,分别占31.71%、15.85%、14.63%、12.20%、10.98%,>2种细菌混合感染10例,细菌合并真菌感染7例;年龄大、营养不良、应用镇静剂及制酸剂、预防使用抗菌药物是引起呼吸机相关性肺炎的危险因素;合并呼吸机相关性肺炎撤机困难多、住院时间长、病死率高。结论 NICU患者合并呼吸机相关性肺炎发生率高,痰培养结果复杂,是多种因素共同作用结果,对预后有不良影响,应采取针对性措施以有效降低呼吸机相关性肺炎发生率。

OBJECTIVE To explore the clinical characteristics of neurological intensive care unit （NICU） patientscomplicated with ventilator-associated pneumonia （VAP） and put forward the prevention measures so as to guidethe clinical diagnosis and treatment. METHODS The clinical data of 80 cases of NICU patients who used ventilatorwere retrospectively analyzed, then the result of sputum cultures,the risk factors,and the impact on prognosiswere observed. RESULTS Of totally 80 cases of patients who used ventilator for supportive treatment, the VAPoccurred in 30 cases with the incidence rate of 37. 50%. Totally 82 strains of pathogens were isolated from the 30patients,including 56 （68. 29%） strains of gram-negative bacteria, 16（19. 51%） strains of gram-positive bacteria,and 10 （12. 20%） strains of fungi; the Pseudomonas aeruginosa , Klebsiella pneumoniae,Staphylococcus aureus,Acinetobacter baumannii,and Candida albicans ranked the top five species of pathogens, accounting for 31. 71%,15.85%,14. 63%,12. 20%,and 10.98%,respectively. There were 10 cases with mixed infections caused bymore than two species of pathogens and 7 cases with mixed bacterial and fungal infections. The advanced age,malnutrition, use of sedative and antacids,and prophylactic use of antibiotics were the risk factors for the VAP. Itwas more difficult for the VAP patients to remove the machine,with the hospitalization duration longer,the mortality higher. CONCLUSION The incidence rate of VAP is high among the NICU patients,the result of sputumculture is really complex, which is a combination effect of multiple factors and has adverse effect on the prognosis.It is necessary to take targeted measures so as to reduce the incidence of VAP effectively.