重症监护病房呼吸机相关性肺炎的菌群分布及治疗

The Distribution of Bacteria and Treatment of Ventilator-associated Pneumonia in ICU

目的对重症监护病房呼吸机相关性肺炎的菌群分布进行探讨,以制定有效的防治方案。方法回顾分析该院监护病房在2011年1月—2014年12月接收治疗的100例呼吸机相关性肺炎患者,分析、检测患者呼吸机相关性肺炎的菌群,以掌握其分布规律,进行对症治疗,观察患者的治疗效果。结果1D0例呼吸机相关性肺炎患者中共收集353份呼吸道分泌物标本,分离出病原菌273株,阳性率占77.3%,均不来自于同一患者,患者的病原菌以革兰阴性杆菌为主,占72.5%,其次是革兰阳性球菌(13.9%)、真菌(13.6%)。革兰阴性杆菌以金黄色葡萄球菌为主,占31.6%。在临床治疗中,由于氨苄青霉素、哌拉西林、头孢曲松钠、氨苄西林、青霉素、头孢唑林、新青Ⅱ等药物的耐药性较高,因此需避免此类药物的使用,以提高患者的临床治疗效果。结论重症监护病房呼吸机相关性肺炎的菌群受到多种因素的影响,因此需给予抗生素干预,且需避免滥用,以降低患者菌群的耐药性。

Objective To discuss the distribution of bacteria of ventilator-associated pneumonia in ICU so as to develop effective treatment plan. Methods 100 patients with ventilator-associated pneumonia treated in the ICU of out hospital from January 2011 to Decemer 2014 were analyzed retrospectively. The distribution of bacteria of ventilator-associated pneumonia of them was ana-lyzed and detected for symptomatic treatment. The treatment effects were observed. Results 353 specimens of respiratory tract of 100 patients with ventilator associated pneumonia were collected, from which 273 species of pathogenic bacteria, every of which were not from the same patient ,were isolated and the positive rate was 77.3%. Patients＇ pathogenic bacteria mainly was gram-neg-ative bacilli, accounted for 72.5%, followed by gram-positive cocci （13.9%） and fungi （13.6%）. Gram negative bacilli was given priority to staphylococcus aureus, accounting for 31.6%. In the clinical treatment, due to the high drug resistance of ampicillin, piperacillin, ceftriaxone sodium, ampicillin, penicillin, cefazolin, new green Ⅱ, we should avoid the use of these drugs in order to improve the clinical therapeutic effect. Conclusion ICU ventilator associated pneumonia bacteria is affected by many factors, so the antibiotics should be given for intervention but not for absue to reduce the drug resistance of the bacteria in patients.