呼吸机相关性气管支气管炎对慢性阻塞性肺疾病预后的影响

Influence of ventilator-associated tracheobronchitis on prognosis of patients with chronic obstructive pulmonary disease

目的探讨呼吸机相关性气管支气管炎(VAT)对慢性阻塞性肺疾病(COPD)患者预后的影响,为临床治疗提供参考依据。方法选取2012年1月-2013年12月RICU住院进行有创机械通气治疗的COPD患者136例,其中13例确诊为VAT,设为VAT组,配对病例13例,设为对照组,比较两组患者预后。结果 13例VAT患者送检标本检出细菌共19株,其中18株为多药耐药菌,占94.7%,对照组7株占77.8%(P<0.05);VAT组混合感染患者6例占46.2%,对照组3例占23.1%(P<0.05);VAT相关的常见病原菌为铜绿假单胞菌、鲍氏不动杆菌和MRSA;VAT组机械通气时间明显延长,为22d,对照组仅为13d(P<0.05);VAT组患者ICU住院时间也明显延长为28d,对照组仅为16d(P<0.05);VAT组中使用恰当抗菌药物治疗的患者为6例占46.2%,与使用非恰当抗菌药物的患者相比,机械通气时间较短,分别为12d和20d,ICU住院时间较短,分别为17d和23d,但上述差异无统计学意义。结论 VAT会导致COPD患者机械通气和ICU住院时间延长,恰当的初始抗菌药物治疗有助于改善VAT患者预后。

OBJECTIVE To explore the influence of ventilator-associated tracheobronchitis （VAT）on prognosis of patients with chronic obstructive pulmonary disease （COPD）so as to provide guidance for clinical treatment. METHODS A total of 136 COPD patients who were hospitalized the RICU for mechanical ventilation from Jan 2012 to Dec 2013 were enrolled in the study,among whom 13 patients with confirmed VAT were assigned as the VAT group,and 13 matched cases were set as the control group;the prognosis was compared between the two groups. RESULTS A total of 1 9 strains of bacteria have been isolated from the submitted specimens obtained from the 1 3 VAT patients,among which the multidrug-resistant bacteria accounted for 94.7% （18 strains ）,and 7 strains were isolated from the control group,accounting for 77.8% （P〈0.05）.There were 6 （46.2%）cases of mixed in-fections in the VAT group and 3 （23.1%）cases in the control group （P〈0.05）.The Pseudomonas aeruginosa, Acinetobacterbaumannii,and MRSA were the common pathogens causing VAT.The median mechanical ventila-tion duration was significantly extended in the VAT group （22 days）,which was 13 days in the control group （P〈0.05）;the median length of ICU stay of the VAT group was 28 days,significantly longer than 16 days of the control group （P〈0.05）.In the VAT group,there were 6 （46.2%）patients who used antibiotics reasonably;the median mechanical ventilation duration of the patients who used antibiotics reasonably was 1 2 days,shorter than 20 days of the patients who did not use antibiotics reasonably;the median length of ICU stay of the patients who used antibiotics reasonably was 17 days,shorter than 23 days of the patients who did not use antibiotics reasona-bly,but there was no significant difference.CONCLUSION The VAT may lead to the extended mechanical ventila-tion duration and length of ICU stay,and appropriate initial drug therapy can improve the prognosis of the pa-tients.