38例呼吸机相关性肺炎临床分析

Clinical Analysis of 38 Patients with Ventilator-associated Pneumonia

目的:了解呼吸内科重症监护病房(RICU)机械通气患者并发呼吸机相关性肺炎(VAP)的临床相关因素和细菌学特点。方法:回顾性分析呼吸机相关性肺炎患者38例发病时间和病原学特点。结果:RICU重症患者机械通气≥48 h 87例,并发VAP 38例,发病率为43.7%。重症患者并发VAP时病死率39.5%。VAP机械通气平均发生在(5.1±2.2)d,与机械通气时间、意识障碍相关;VAP致病菌以革兰氏阴性杆菌感染为主,占81.1%,药敏试验显示对多种常用抗生素耐药。结论:RICU呼吸机相关性肺炎发生率、病死率高,革兰氏阴性杆菌仍为主要病原菌,尽可能缩短呼吸机使用时间、合理使用抗生素、严格无菌操作,有利于呼吸机相关性肺炎控制。

Objective To review the clinical associatd factors and the bacterial features ofventilator associated pneumonia(VAP) caused by mechanical ventilation in RICU.Methods The clinical data of 38 patients with ventilator associated pneumonia were retrospectively analyzed.Results 87 cases treated by mechanical ventilation over 48 hours,38 cases were diagnosed as VAP(43.7%);Severe cases with ventilator associated pneumonia death rate was39.5%.Mean time for the occurance of VAP was(5.1±2.2) days,the duration of mechanical ventilation and conscious disturbance were realted to the development of VAP.The main pathogenic bacteria of the patients with VAP were Gram negative bacilli(81.1%),Which had drug resistance toma-jority of the commonly used antibiotics by the results of susceptibility test.Conclusion The occurrence and death rates of VAP were high in RICU,Gram negative bacilli is still the main pathogenic bacteria,reducing the duration of mechanical ventilation,strict sterile operation and rational antibiotics treatment can reduce the occurrence of VAP.