156例呼吸机相关性肺炎临床治疗分析

Analysis of the Clinical Treatment of 156 Cases of Ventilator-associated Pneumonia

目的研究探讨呼吸机相关性肺炎临床治疗的疗效及安全性。方法回顾性分析该院2010年1月1日—2012年12月31日期间收治的156例呼吸机相关性肺炎患者的临床资料,观察机械通气48 h以上患者,通过患者体温、气管内吸出脓性分泌物、外周血白细胞、痰细菌培养、X线胸片,诊断呼吸机相关性肺炎,将患者随机分为两组,分别采用头孢他啶和头孢哌酮/舒巴坦进行治疗,对比两组患者疗效的结果以及细菌清除率情况。分析其致病菌,进行汇总。结果观察组患者的治疗效果以及细菌清除率情况均显著好于对照组(P<0.05)。机械通气48 h以上患者中78.2%有呼吸机相关性肺炎。单纯致病菌35例,≥2种致病菌35例。病原菌培养结果:金黄色葡萄球菌27例、铜绿假单胞菌29例、白色念珠菌17例、克雷伯杆菌13例。结论头孢哌酮/舒巴坦治疗肺炎的疗效较好,绿假单胞菌、金黄色葡萄球菌、白色念珠菌等是呼吸机相关性肺炎的主要致病菌,该研究就呼吸机相关性肺炎的流行病学及诊断作出综述并进行积极防治,缩短患者机械通气时间、提高生存率。

Objective The paper intensively studies and discusses the effect and safety of clinical treatment of ventilator-associat- ed pneumonia. Methods The clinical data of 156 cases of patients with ventilator-associated pneumonia admitted in our hospital from January 1st, 2010 to December 31st, 2012 were analyzed retrospectively. Patients with mechanical ventilation for more than 48 h were observed. Ventilator-associated pneumonia was diagnosed through the patient＇s body temperature, endotracheal aspirates purulent secretions, peripheral white blood cells, bacterial culture of sputum and X-ray. The patients were randomly divided into two groups, and were treated with ceftazidime, cefoperazone/sulbactam, respectively. The efficacy as well as the bacterial clearance rate was compared between the two groups. The pathogens bacteria were analyzed and summarized. Results The therapeutic effect and bacterial eradication rate of the patients in the observation group were significantly better than those of the control group （P〈 0.05）. 78.2% of the patients with mechanical ventilation for more than 48 h had ventilator-associated pneumonia. There were sim- ple pathogens in 35 cases, greater than or equal to 2 kinds of pathogenic bacteria of 35 cases. Results of pathogenic bacteria cul- ture： Staphylococcus aureus in 27 cases, Pseudomonas aeruginosa in 29 cases, 17 cases of Candida albicans, Klebsiella pneumoni- ae in 13 cases. Conclusion Cefoperazone/Sulbactam has better curative effect in the treatment of pneumonia. Pseudomonas aerugi- nosa, Staphylococcus aureus, Candida albicans and so on are the main pathogens of ventilator-associated pneumonia. This paper reviews the epidemiology and diagnosis of ventilator-associated pneumonia and positively prevents and treats the disease so as to shorten the duration of mechanical ventilation in patients and improve the survival rate of the patients.