新生儿重症监护病房呼吸机相关肺炎50例临床分析

Clinical analysis of 50 cases of ventilator associated pneumonia in neonatal intensive care units

目的探讨导致新生儿重症监护病房(NICU)机械通气患儿并发呼吸机相关肺炎(VAP)的相关因素。方法对2011年1月至2012年12月NICU行机械通气的410例患儿的一般资料、原发疾病、VAP感染发生比例及病原学检查情况进行回顾性分析。结果 410例机械通气患儿共发生VAP 50例,其中早产儿21例,足月儿29例,VAP发病率为12.20%(50/410);VAP病原学检查结果显示,革兰阳性菌占74.00%(37/50),革兰阴性菌占24.00%(12/50),真菌占2.00%(1/50);2011年行机械通气183例,发生VAP 12例,感染率6.56%(12/183),2012年行机械通气227例,发生VAP 38例,感染率16.74%(38/227),2年感染率比较,差异有统计学意义(P<0.05)。结论近2年NICU机械通气患儿VAP的发生有增加趋势,病原菌感染以革兰阳性菌多见。

Objective To investigate the related factors leading to ventilator associated pneumonia （VAP） in neonatal intensive care units（NICU）. Methods Retrospective analysis was conducted on general data,primary disease,occurrence ratio of VAP infection and etiological examination condition of 410 patients under mechanical ventilation in NICU from January 2011 to December 2012. Results Of the 410 neonates with mechanical ventilation,VAP occurred in 50 cases,including 30 preterm infants and 29 term infants with the incidence rate of 12.20%. The VAP pathogens examination revealed that gram-positive bacteria accounted for 74%（37/50）,gram-negative bacteria accounted for 24%（12/50） and fungal infections accounted for 2%（1/50）. Among the 183 neonates under mechanical ventilation in the year of 2011 ,VAP occurred in 12 cases with the infection rate of 6.56%;among the 227 neonates under mechanical ventilation ,VAP occurred in 38 cases with the infection rate of 16.74%, and the difference on infection rate between the two years had statistical significance （P＆lt;0.05）. Conclusion In recent two years,the incidences rate of the neonates with VAP under has an upward tendency ,and the gram-positive bacteria is common of the pathogenic bacteria.