机械通气患儿VAP的病原菌分布特征及炎性因子监测的价值

Distribution Characteristics of VAP Pathogens in Children with Mechanical Ventilation and the Value of Inflammatory Factor Monitoring

目的探讨机械通气患儿呼吸机相关肺炎(VAP)的病原菌分布特征及炎性因子监测的价值。方法270例接受机械通气的患儿根据VAP发生情况分为VAP组和非VAP组,比较两组的炎性因子水平。记录VAP患儿的病原菌检出情况,分析病原菌分布情况及耐药率。结果172例VAP患儿共培养分离出205株病原菌,其中144株为革兰阴性菌,57株为革兰阳性菌,4株真菌。肺炎克雷伯菌、铜绿假单胞菌均对庆大霉素的耐药率最高,对亚胺培南、美罗培南的敏感性较高。VAP组的PCT、CRP、IL-6、IL-10、TNF-α水平均高于非VAP组(P<0.05)。结论机械通气患儿VAP的感染病原菌主要为革兰阴性菌,临床早期治疗可选用革兰阴性菌敏感性药物,监测炎性因子表达情况有助于早期预测VAP的发生。

Objective To explore the distribution characteristics of ventilator-associated pneumonia(VAP)pathogens in children with mechanical ventilation and the value of inflammatory factor monitoring.Methods According to the occurrence of VAP,270 children with mechanical ventilation were divided into VAP group and non-VAP group,and the levels of inflammatory factors were compared between the two groups.The detection of pathogenic bacteria in children with VAP was recorded,and the distribution and drug resistance rate of pathogenic bacteria were analyzed.Results A total of 205 strains of pathogenic bacteria were isolated from 172 children with VAP,including 144 strains of gram-negative bacteria,57 strains of gram-positive bacteria and 4 strains of fungi.Both Klebsiella pneumoniae and Pseudomonas aeruginosa had the highest resistance rates to gentamicin,and had higher sensitivity to imipenem and meropenem.The levels of PCT,CRP,IL-6,IL-10 and TNF-αin VAP group were higher than those in non-VAP group(P<0.05).Conclusions Gram-negative bacteria are the main infection pathogens of VAP in children with mechanical ventilation.Sensitive drugs to gram-negative bacteria can be used for early clinical treatment.Monitoring the expressions of inflammatory factors is helpful to predict the occurrence of VAP in the early stage.