重症监护室呼吸机相关性肺炎发生的危险因素和病原菌分布及药敏分析

Distribution of Risk Factors and Pathogens of Ventilator-associated Pneumonia in ICU and Drug Sensibility Analysis

目的:认知导致呼吸机相关性肺炎(VAP)的危险因素,为预防和治疗VAP提供理论依据。方法:采用病例对照研究的方法,对190例接受机械通气支持的ICU患者的临床资料进行分析。结果:我院VAP的发生率为48.4%;高龄(>65岁)、机械通气时间过长(>5 d)、使用糖皮质激素、使用制酸药物、留置胃管、多种抗生素合用为VAP发生的危险因素;162株病原菌中,革兰阳性菌39株(24.07%),革兰阴性杆菌102株(62.96%),真菌21株(12.96%);多数病原菌存在多重耐药性。结论:多种因素与VAP的发生密切相关;病原菌分布以革兰阴性杆菌为主;菌株多重耐药性现象较普遍。采取对高龄患者加强监护,提高其免疫力;合理使用激素类药物;尽量缩短机械通气支持的时间,做好撤机计划;留置胃管及进行肠内营养支持的患者,抬高其床头、做好口腔清洁;医护人员在日常操作中严格遵循无菌原则,做好手部卫生,合理使用抗菌药物等措施可降低VAP的发生率。

OBJECTIVE： To analyze the risk factors, pathogens and drug sensitivity test of ventilator-associated pneumonia （VAP） in ICU. METHODS： A case-control study was conducted to analyze the clinical data of 190 patients receiving mechanical ventilatory support in ICU. RESULTS： The incidence of VAP in our hospital was 48.4 %; elderly patients （~65 years）, duration of mechanical ventilation （〉 5 d）, use of corticosteroids, antacid drugs, indwelling stomach tube, and combined use of antibiotics were the risk factors of VAP; among the 162 pathogens, 39 were Gram-positive bacteria （24.07 % ）, 102 were Gram-negative bacte- ria （62.96%）, 21 were fungi （12.96%）; multi-drug resistance existed in most pathogens. CONCLUSIONS： A variety of factors are closely associated with the incidence of VAP; the main pathogens of VAP are Gram-negative bacteria; the phenomenon of multi-drug resistance is common. Some measures are adopted to decrease the incidence of VAP, such as strengthen monitoring of el- derly patients, to improve their immunity;use hormonal drugs reasonably; shorten the course of mechanical ventilation as much as possible, and plan ventilator removal; elevate the head of the bed and clean the oral for patients receiving gastric canal implantation and enteral nutrition;clean hands in accordance with asepsis principle strictly, and use antibacterials reasonalbly.