呼吸机相关性肺炎的高危因素与病原菌感染特征分析

Analysis of High Risk Factors and Features of Pathogenic Bacteria Infection in Ventilator-associated Pneumonia

【目的】探讨院内呼吸机相关性肺炎（VAP）发生的高危因素与病原菌感染特征及相关预防对策，为临床干预提供参考，提高医院感染控制水平。【方法】回顾性分析2013年1～11月本院ICU进行机械通气≥48 h患者117例临床资料，其中诊断符合 VAP的患者53例，未发生 VAP 64例，对53例 VAP患者的高危因素与病原菌感染特征进行分析。【结果】在 VAP 患者的气道分泌物中，分离得到病原菌72株，以革兰阴性杆菌为主，占69．44％（50/72），其中铜绿假单胞菌为最常见菌（32．0％），其次为不动杆菌属、金黄色葡萄球菌、大肠埃希菌等；鲍曼不动杆菌药敏显示多药耐药特征，合并真菌感染率较高，占11．32％（6/53）。患者的年龄、长时间机械通气、使用镇静剂、APACHEⅡ评分等与 VAP发生有显著相关性；皮质激素不是 VAP 发生的主要危险因素。【结论】VAP的病原菌以革兰阴性杆菌为主，VAP的发生与多种临床因素有关，对这类因素应尽量控制，以降低 VAP的发生率、病死率。

[Objective]To explore high risk factors,features of pathogenic bacteria infection and the relevant prevention of ventilator-associated pneumonia（VAP）in order to provide the reference for clinical intervention and improve the control level of hospital infection.[Methods]Clinical data of 1 1 7 patients given mechanic ventilation over 48 hours in ICU from Jan.2013 to Nov.2013 were analyzed retrospectively.Among them,53 patients accor-ded with the diagnosis of VAP and 64 patients had no VAP.High risk and features of pathogenic bacteria infection of 53 patients with VAP were analyzed.[Results]The 72 strains of pathogenic bacteria were isolated from airway secretions in VAP patients.The main bacterium was gram negative bacilli（69.44%,50/72）.The first three pathogens were Pseudomonas aeruginosa（32.0%）,Acinetobacter,Staphylococcus aureus and Escherichia coli. The drug sensitivity of Acinetobacter baumannii presented multidrug resistance.The rate of the mixed infection with fungi was higher（11.32%,6/53）.The patients＇age,long-time mechanical ventilation,the usage of sedatives and APACHEⅡ score were significantly correlated with the incidence of VAP.Corticosteroids were not the main risk factors of VAP.[Conclusion]The main pathogenic bacterium of VAP is gram negative bacilli.The incidence of VAP is correlated with multiple clinical factors.These factors should be controlled as for as possible in order to reduce the incidence and mortality of VAP.