重症脑梗死患者呼吸机相关性肺炎的特征与危险因素分析

Etiological characteristics of ventilator-associated pneumonia in patients with severe cerebral infarction and analysis of risk factors

目的探讨重症脑梗死患者实施机械通气后发生呼吸机相关性肺炎(VAP)病原学特点及危险因素,为临床诊治提供参考。方法选择2010年5月-2014年12月1 024例重症脑梗死患者,228例患者实施机械通气发生呼吸机相关性肺炎,分析其病原菌分布及耐药性,分析发生VAP的危险因素。结果 228例患者共分离出256株病原菌,其中革兰阴性菌196株占76.56%,革兰阳性菌60株占23.44%,肺炎克雷伯菌、金黄色葡萄球菌为主要病原菌,革兰阴性菌对亚胺培南耐药率低,革兰阳性菌对万古霉素、利福平耐药率较低;机械通气时间、侵入性操作、误吸、肺部基础疾病、营养不良是发生VAP的危险因素。结论金黄色葡萄球菌、肺炎克雷伯菌是VAP的主要病原菌,耐药机制复杂,针对发生VAP的危险因素采取相应措施,以降低VAP发生率。

OBJECTIVE To explore the etiological characteristics of ventilator-associated pneumonia（VAP）in the severe cerebral infarction patients undergoing mechanical ventilation and analyze the risk factors so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 1 024 patients with severe cerebral infarction who were treated in the hospital from May 2010 to Dec 2014 were enrolled in the study,of whom 228 had the VAP due to the mechanical ventilation.The distribution and drug resistance of the pathogens were analyzed,and the risk factors for the VAP were observed.RESULTS Totally 256 strains of pathogens were isolated from 228 patients,including 196（76.56%）strains of gram-negative bacteria and 60（23.44%）strains of gram-positive bacteria.The Klebsiella pneumoniae and Staphylococcus aureus were the predominant species of pathogens.The drug resistance rate of the gram-negative bacteria to imipenem was low,and the drug resistance rates of the gram-positive bacteria to vancomycin and rifampicin were low.The risk factors for the VAP included the mechanical ventilation,invasive operation,aspiration,underlying pulmonary disease,and malnutrition.CONCLUSION S.aureus and K.pneumoniae are dominant among the pathogens causing the VAP,and the drug resistance mechanisms are complex.It is necessary to take targeted measures according to the risk factors for the VAP so as to reduce the incidence of the VAP.