气管抽吸标本微生物检测在预测新生儿呼吸机相关性肺炎预后中的应用

Microbiological detection of tracheal aspiration specimen in prediction of prognosis of neonatal ventilator-associated pneumonia

目的气管抽吸标本微生物检测在预测新生儿呼吸机相关性肺炎中的作用。方法选择2016年4月-2018年4月本院NICU患儿359例,其中符合VAP诊断标准患儿172例,设为VAP组;不符合VAP诊断标准的患儿187例,设为对照组。检测呼吸道病原菌情况以及患儿预后。结果对照组和VAP组的胎龄、出生体重、机械通气时间存在明显差异。VAP组中106例(61.63%)患儿为革兰阴性菌阳性,38例患儿为革兰阳性菌(22.09%)阳性,28例(16.28%)患儿为真菌阳性。革兰阴性菌中以肺炎克雷伯菌(20.93%)为主,其次是嗜麦芽窄食单胞菌(16.86%)。革兰阳性菌中以金黄色葡萄球菌(9.88%)和溶血葡萄球菌为主(5.81%)。鲍曼不动杆菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌、白假丝酵母菌与VAP患儿死亡存在弱相关性。结论 NICU患儿因为机械通气引起上呼吸道或其他部位的病原菌定植于肺部引起VAP。部分细菌检出率增加预示患儿预后较差。

Objective To explore the role of microbiological detection of tracheal aspiration specimen in the prediction of prognosis of neonatal ventilator-associated pneumonia（VAP）.Methods 359 children in the NICU of our hospital from April 2016 to April 2018 were enrolled.Among them,172 children who met the diagnostic criteria of VAP were divided into the VAP group,while the other 187 who did not met the criteria were as the controls.The detection of pathogens in respiratory tract and diagnosis of the patients were analyzed.Results There were significant differences in gestational age,birth weight and time length of mechanical ventilation between the two groups.In the VAP group,106（61.63%）children were detected as positive for Gram-negative bacteria,38 were positive for Gram-positive（22.09%）bacteria,and 28（16.28%）were positive for fungi.Gram-negative bacteria were mainly Klebsiella pneumoniae（20.93%）,followed by Stenotrophomonas maltophilia（16.86%）.The main Gram-positive bacteria were Staphylococci aureus（9.88%）and Staphylococci haemolyticus（5.81%）.Acinetobacter baumannii,Klebsiella pneumoniae,Stenotrophomonas maltophilia,Staphylococcus aureus and Candida albicans were weakly correlated with the death of children with VAP.Conclusion Children in the neonatal intensive care unit suffer from damage to the respiratory tract due to mechanical ventilation,causing colonization of the pathogens in upper respiratory tract or other sites into the lungs,which results in VAP;the increase of some bacteria indicates poor prognosis.