183例早发性VAP和晚发性VAP临床观察

Clinical observation of 183 cases on early-onset VAP and lateonset VAP

目的：通过对有创机械通气时间超过48h患者的临床资料进行回顾性分析，比较早发性和晚发性VAP相关危险因素、发生率、病死率以及病原菌流行病学特点，为防治VAP提供科学依据。方法回顾性分析2008年5月～2011年9月间在我院ICU科住院治疗的183例VAP患者的临床资料，将VAP患者分为早发性VAP（EOP）组和晚发性VAP（LOP）组。观察比较两组患者相关危险因素；对两组患者的微生物学资料进行调查。结果EOP和LOP的发生率分别为26.78%和73.22%，病死率分别为20.41%和41.04%。GCS评分6～9分时LOP多见，在10～14分时EOP多见。住院时间＜7d时间段内EOP患者多于LOP患者；住院时间＞14d时间段LOP患者多于EOP患者（P＜0.05）。G-菌的构成比在LOP组及EOP组中均占优势。嗜麦芽寡养单胞菌多见于LOP，肺炎克雷伯氏菌多见于EOP。≥2种病原菌混合感染及合并真菌感染LOP患者多于EOP患者（P＜0.05）。结论尽量避免VAP相关危险因素，早期诊断、早期治疗，对降低VAP的发病率和病死率具有重要意义。

Objective To retrospectively analyze clinical data of patient in invasive mechanical ventilation more than 48 hours and compared early-onset and late-onset VAP-related risk factors, incidence, mortality and epidemiological characteristics of pathogens, to provide scientific basis for combating VAP. Methods A clinical data of 183 cases of patients with VAP treated in ICU department our hospital from May 2008 to September 2011 was retrospective analyzed and divided into early-onset VAP （EOP） and late-onset VAP group （LOP） group. Two groups of patients with associated risk factors were observed and compard; and both groups of patients microbiology data were investigated. Results Incidence of EOP and LOP were 26.78%and 73.22%,respectively, mortality were 20.41%and 41.04%. LOP was more common with GCS score 6-9, shared EOP common with GOS score 10 to 14. less than 7 days period in hospitalization EOP was more than LOP in patients;longer than 14 days time period in hospitalization LOP was more than EOP in patients （P 〈 0.05）. Constituent ratio of G- bacteria was competitive in both LOP and EOP group. Stenotrophomonas maltophilia was prevalent in the LOP, Klebsiella pneumoniae was prevalent in the EOP. LOP with more than 2 kinds of mixed infection and fungal infection was more than EOP （P〈0.05）. Conclusion To avoid VAP-related risk factors, early diagnosis, early treatment, to reduce the incidence and mortality of VAP will be great of significance.