有创机械通气发生早发性呼吸机相关性肺炎的临床研究

Clinical Study of Early-Onset Ventilator-Associated Pneumonia in Patients with Invasive Mechanical Ventilation

目的:观察有创机械通气发生早发性呼吸机相关性肺炎(VAP)的临床特征。方法:回顾性分析2014年10月~2019年9月本科室40例确诊的有创机械通气的患者的临床资料,对引发早发性VAP的相关因素、呼吸道感染菌群的特点以及耐药性等进行分析。结果:治疗后,本组13例(32.50%)患者气管插管或气管切开术后4d内发生早发性VAP;经气道分泌物菌群培养后共获得12株致病菌,多数多重耐药菌;与未发生早发性VAP患者对比,年龄高、肺部疾病史、气管插管或气管切开术前大量使用抗生素是诱发早发性VAP的主要因素(P<0.05)。结论:有创机械通气治疗时,年龄、合并慢阻肺疾病史等因素均可引发早发性VAP发生,术前使用抗生素可能与患者对致病菌的高度耐药因素有关。

Objective:To observe the clinical characteristics of early-onset ventilator-associated pneumonia(VAP)in patients with invasive mechanical ventilation.Methods:Retrospective analysis of 40 cases of patients with invasive mechanical ventilation in our department from October 2014 to September 2019.The related factors causing early-onset VAP,characteristics of respiratory tract infection flora and drug resistance were analyzed.Results:After treatment,13 patients(32.50%)developed early-onset VAP within 4 days after tracheal intubation or tracheotomy;12 strains of pathogenic bacteria were obtained after the culture of airway secretion flora,most of which were multi drug-resistant bacteria;compared with patients without early-onset VAP,age,history of pulmonary disease,large amount of antibiotics before tracheal intubation or tracheotomy were the main factors inducing early-onset VAP(P<0.05).Conclusion:In the treatment of invasive mechanical ventilation,age,history of COPD and other factors can cause the occurrence of early-onset VAP.The use of antibiotics before surgery may be related to the patient's high resistance to pathogenic bacteria.