ICU患者下呼吸道菌群与呼吸机相关性肺炎相关性分析

Correlation between inferior respiratory tract flora and ventilator-associated pneumonia in patients in ICUs

目的研究ICU患者下呼吸道菌群与呼吸机相关性肺炎(VAP)的相关性。方法选择2017年1月-2017年12月在新疆医科大学第一附属医院ICU治疗的患者199例。采用自行设计的调查表研究患者基本资料,检测患者血液、痰液、支气管肺泡灌洗液和胸腔积液中病原体分布。结果 ICU患者VAP发病率为34.17%。VAP平卧位患者比例和机械通气时间超过5d的患者比例明显高于非VAP患者(P=0.000)。VAP患者鲍曼不动杆菌(P=0.000)、肺炎克雷伯杆菌(P=0.000)、铜绿假单胞菌(P=0.000)、阴沟肠杆菌(P=0.039)、金黄色葡萄球菌(P=0.000)、表皮葡萄球菌(P=0.000)、草绿色链球菌(P=0.039)、肠球菌(P=0.039)和白假丝酵母菌(P=0.018)的检测率明显高于非VAP患者。VAP患者发病与病原微生物分布相关:鲍曼不动杆菌(r=0.3274)、肺炎克雷伯杆菌(r=0.3274)、金黄色葡萄球菌(r=0.2975)和白假丝酵母菌(r=0.2371)与VAP发生存在相关性。结论 ICU患者容易发生VAP,病原体以革兰阴性菌为主,其次是革兰阳性菌,第三位是真菌,ICU患者VAP发病率随机械通气时间增加而增加,平卧位患者的VAP发病率更高。

Objective To explore the association between inferior respiratory tract flora and ventilator-associated pneumonia in ICU patients.Methods 198 patients admitted in ICUs in our hospital from January 2017 to March 2018 were enrolled.The self-designed questionnaire was used to analyze the basic data of patients;the distribution of pathogens in blood,sputum,bronchoalveolar lavage fluid and pleural effusions were detected.Results The incidence of VAP in ICU patients was 34.17%.The proportions of VAP patients resting in supine position and those with mechanical ventilation longer than 5 days were significantly higher than that of non-VAP patients（P=0.000）.The detection rates of Acinetobacter baumannii（P=0.000）,Klebsiella pneumoniae（P=0.000）,Pseudomonas aeruginosa（P=0.000）,Enterobacter cloacae（P=0.039）,Staphylococcus aureus（P=0.000）,Staphylococcus epidermidis（P=0.000）,Streptococcus viridans（P=0.039）,Enterococcus（P=0.039）and Candida albican（P=0.018）in VAP patients were significantly higher than those in non-VAP patients respectively.The incidence of VAP was related with the distribution of pathogens.The results showed that Acinetobacter baumannii（r=0.3274）,Klebsiella pneumoniae（r=0.3274）,Staphylococcus aureus（r=0.2975）and Candida albicans（r=0.2371）were related with the occurrence of VAP.Conclusion There was high incidence of VAP in ICU patients in our hospital.The pathogens are mainly Gram-negative bacteria,followed by Gram-positive bacteria and then fungi.The incidence of VAP in ICU patients increased with the increase of mechanical ventilation time,especially in patients taking supine position.