机械通气中心静脉导管感染患者肺功能及病原学特点研究

Pulmonary function and pathogenic characteristics in patients with central venous catheter infection in mechanical ventilation

目的探究行机械通气中心静脉导管发生中心静脉导管相关性血流感染(CRBSI)患者的肺功能及病原菌分布和耐药性。方法选取2012年8月-2016年12月于医院接受治疗的52例行机械通气留置中心静脉导管发生CRBSI患者列为感染组,同时选取同时期在医院治疗的58例相同未发生CRBSI患者列为未感染组。分析感染组患者感染的病原菌分布及主要菌群对常用抗菌药物的药敏结果,对比两组患者肺功能的相关指标。结果感染组52例患者共分离病原菌60株,其中革兰阳性菌39株占65.00%,以表皮葡萄球菌及金黄色葡萄球菌为主,革兰阴性菌21株占35.00%,以肺炎克雷伯菌及大肠埃希菌为主。药敏结果显示,革兰阳性菌对青霉素、庆大霉素、阿奇霉素等的耐药率较高,最高为100.00%,对万古霉素较敏感;革兰阴性菌对阿莫西林、妥布霉素及庆大霉素等耐药率较高,最高为100.00%,对亚胺培南较敏感。感染组患者肺功能指标肺活量(FVC)、第1秒呼气容积(FEV1)及FEV1/FVC分别为(1.99±0.28)L、(3.19±0.21)L、(49.12±6.54)%显著低于未感染组(2.36±0.31)L、(3.45±0.63)L、(54.21±6.89)%(P<0.05)。结论 CRBSI会导致行机械通气中心静脉导管患者肺功能下降,建议采用严格遵守无菌操作原则等防治措施,早期降低患者感染风险。

OBJECTIVE To explore the pulmonary function,distribution of pathogenic bacteria and drug resistance CRBSI patients with central venous catheter in mechanical ventilation.METHODS A total of 52 cases of mechanical ventilation indwelling central venous catheter for patients with CRBSI in our hospital for treatment from Aug.2012 to Dec.2016 were selected as infection group.and 58 cases of patients without CRBSI at same period in our hospital were set as uninfected group.The distribution of pathogens and the drug sensitivity to commonly used antibacterial drugs were analyzed,and the pulmonary function related indexes between the two groups of patients were compared.RESULTS A total of 60 strains of pathogens were isolated from 52 patients of infection group,including 39 strains of gram-positive bacteria,accounting for 65%,which were mainly Staphylococcus epidermidis and Staphylococcus aureus,and 21 strains of gram-negative bacteria,accounting for 35%,which were mainly Klebsiella pneumoniae and Escherichia coli.Drug sensitivity test results showed that gram-positive bacteria had high resistant rates to penicillin,gentamicin and azithromycin,and the highest rate was 100%,and were sensitive to vancomycin.Gram-negative bacteria had high resistant rates to amoxicillin,tobramycin and gentamicin,and the highest rate was 90.48%,and were sensitive to imipenem.FEV1,FVC and FEV1/FVC in infection group were（1.99±0.28）L,（3.19±0.21）L,and（49.12±6.54）%,which were significantly lower than（2.36±0.31）L,（3.45±0.63）L and（54.21±6.89）%in uninfected group（P〈0.05）.CONCLUSION CRBSI will lead to pulmonary function decline in patients with mechanical ventilation for central venous catheter,it is suggested the clinical use of the principles of aseptic control measures strictly,so as to reduce the risk of infection in patients with early.