脑梗死机械通气患者呼吸机相关肺炎病原学及相关因素分析

Ventilator-associated pneumonia etiology and its related factors in acute ischemic stroke patients on mechanical ventilation

目的探讨重症脑梗死进行机械通气后的呼吸机相关肺炎(VAP)发病的相关因素。方法选择137例重症脑梗死行机械通气患者,将发生VAP 56例作为VAP组,未发生VAP 81例作为非VAP组,比较2组临床资料,VAP组检测痰标本中病原菌并分析。结果 VAP组与非VAP组机械通气时间、ICU住院时间比较,差异有统计学意义(P<0.01)。VAP组共检测出89株细菌,革兰阴性杆菌68株,革兰阳性球菌21株,最常见的病原菌依次为金黄色葡萄球菌18株、鲍曼不动杆菌17株、铜绿假单胞菌15株。18株金黄色葡萄球菌中,17株为耐甲氧西林金黄色葡萄球菌,其仅对糖肽类及利奈唑烷敏感性好。鲍曼不动杆菌耐药率较高,对包括碳青酶烯在内的抗生素耐药率均>60%。结论机械通气时间是重症脑梗死患者VAP发生重要的独立危险因素,革兰阴性杆菌及耐甲氧西林金黄色葡萄球菌是导致重症脑梗死患者VAP的主要病原菌,并且其耐药性高。

Objective To provide the guidance for preventing ventilator-associated pneumonia （VAP） and use of antimicrobial agents in severe cerebral infarction （SCI） patients on mechanical ventilation （MV） by studying the risk factors for VAP. Methods One hundred and thirty-seven SCI patients on mechanical ventilation were divided into VAP group （n= 56） and non-VAP group （n=81）. Their clinical parameters were compared. VAP. Results The MV time and ICU stay time were significantly longer in VAP group than in non-VAP group （P^0.01）. A total of 89 bacterial strains were detected in sputum samples, including 68 strains of G-bacteria and 21 strains of G＋ coccobacteria. The most common pathogen was Staphylococcus aureus （18） followed by Acinetobaumannii （17） and Pseudomonas aeruginosa （15）. Of the 18 strains of Staphylococcus aureus,17 were MRSA which were sensitive to sugar peptide and rinathiazole. The resistance of Acinetobaumannii strains was 〉60% to different antibiotics. Conclusion MV time is an independent risk factor for VAP in SCI patients. Gbacteria and MRSA are the major pathogens of VAP in SCI patients with a high drug resistance.