ICU患者下呼吸道感染的影响因素研究

Influencing factors for lower respiratory tract infections in ICU patients

目的研究ICU患者应用有创呼吸机发生下呼吸道感染的影响因素,提出针对性的对应措施,提高患者的预后。方法回顾性分析2012年6月-2013年6月ICU应用有创呼吸机患者132例临床资料,将其中发生下呼吸道感染的42例患者设为感染组,未发生感染的90例患者设为未感染组,分析两组患者的临床资料,探讨发生感染的影响因素,提出对应措施;数据采用SPSS13.0统计处理。结果 ICU应用有创呼吸机患者下呼吸道感染发生率为31.82%;合并糖尿病、基础疾病种类多、带机时间长、高龄、病情严重程度、插管方式等因素是导致应用有创呼吸机患者下呼吸道感染的主要因素,感染与非感染组间比较差异有统计学意义(P<0.05);42例感染患者共培养出病原菌47株,主要为革兰阴性菌31株占65.96%,其次革兰阳性菌9株占19.15%,真菌7株占14.89%;前5位的病原菌分别是铜绿假单胞菌、白色假丝酵母菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌,分别占25.53%、14.89%、12.77%、10.64%、10.64%。结论 ICU应用有创呼吸机患者下呼吸道感染的发生率较高,影响因素众多,在治疗时应进行综合评估,早期敏感抗菌药物应用,积极治疗原发疾病,是降低感染发生率及提高感染患者预后的主要对应措施。

OBJECTIVE To study the influencing factors for lower respiratory tract infections m the IUU patients who used invasive ventilator and propose targeted coping measures so as to improve the prognosis of patients. METHODS The clinical data of 132 patients who underwent invasive mechanical ventilation in the ICU from Jun 2012 to Jun 2013 were retrospectively analyzed, then 42 patients with lower respiratory tract infections were as- signed as the infection group, and 90 patients without infections were set as the non-infection group~ the clinical data of the two groups of patients were analyzed, the influencing factors for infections were explored so as to put forward coping measures, and the statistical analysis of data was performed with the use of SPSS13.0 software. RESULTS The incidence of lower respiratory tract infections was 31.82 % in the ICU patients who underwent the invasive mechanical ventilation. The complication of diabetic mellitus, multiple underlying diseases, long duration of ventilation, advanced age, severity of illness, and types of intubation were the major factors resulting in the lower respiratory tract infections, and there were significant differences between the infection group and the non- infection group （P^0.05）. A total of 47 strains of pathogens have been isolated from the 42 patients with infec- tions, including 31 （65.96%） strains of gram-negative bacteria, 9 （19.15%） strains of gram-positive bacteria, and 7 （14.890%） strains of fungi~ the Pseudomonas aeruginosa , Candida albicans , K lebsiella pneumoniae , Acin- etobacter baumannii, and Staphylococcus aureus ranked the top five species of pathogens, accounting for 25.53 %, 14.89%, 12.77%, 10.64%, and 10.64%, respectively. CONCLUSION The incidence of lower respiratory tract infections is high in the ICU patients undergoing the invasive mechanical ventilation, and there are a variety of influencing factors. It is necessary to conduct comprehensive assessment, use sensitive antibiotics in early stage, and actively treat primary diseases so as to reduce the incidence of infections and improve the prognosis of the patients.