Objective A prospective study was conducted in a tertiary care center to identify the risk factors of ventilator associated pneumonia(VAP) through phenotypic and molecular biological methods. Methods The patients who ...Objective A prospective study was conducted in a tertiary care center to identify the risk factors of ventilator associated pneumonia(VAP) through phenotypic and molecular biological methods. Methods The patients who were mechanically ventilated in the respiratory intensive care unit(RICU) and the neurological internal intensive care unit(NICU) were enrolled in our study, and samples were collected from the lower respiratory tract, oropharynx and stomach. Other samples, including the environmental air, swabs of nurses' hands, subglottic secretion and ventilator circuit, were also collected. Microorganisms in the collected samples were recovered and identified at species level by biochemical detection. Genetic relationship of dominant species was further characterized by pulsed field gel electrophoresis(PFGE). Results Out of 48 enrolled patients, 22 cases developed VAP and bacterial cultures were recovered from the lower respiratory tract samples of 14 cases. The average hospitalization time with VAP was significantly longer than that of patients without VAP(P < 0.05). Among the recovered bacteria cultures, multidrug-resistant Pseudomonas aeruginosa and Stenotrophomonas maltophilia were dominant. It was more likely that subglottic secretion and gastric juice samples contained the same isolates as recovered in the lower respiratory tract by PFGE analysis. Conclusions Mechanical ventilation in RICU and NICU was a high risk factor for VAP development. Special emphasis of VAP prophylaxis should be paid on subglottic secretion and gastric juice reflux.展开更多
基金supported by the grant (2005DIB3J159) from the Ministry of Science and Technology of the People's Republic of China
文摘Objective A prospective study was conducted in a tertiary care center to identify the risk factors of ventilator associated pneumonia(VAP) through phenotypic and molecular biological methods. Methods The patients who were mechanically ventilated in the respiratory intensive care unit(RICU) and the neurological internal intensive care unit(NICU) were enrolled in our study, and samples were collected from the lower respiratory tract, oropharynx and stomach. Other samples, including the environmental air, swabs of nurses' hands, subglottic secretion and ventilator circuit, were also collected. Microorganisms in the collected samples were recovered and identified at species level by biochemical detection. Genetic relationship of dominant species was further characterized by pulsed field gel electrophoresis(PFGE). Results Out of 48 enrolled patients, 22 cases developed VAP and bacterial cultures were recovered from the lower respiratory tract samples of 14 cases. The average hospitalization time with VAP was significantly longer than that of patients without VAP(P < 0.05). Among the recovered bacteria cultures, multidrug-resistant Pseudomonas aeruginosa and Stenotrophomonas maltophilia were dominant. It was more likely that subglottic secretion and gastric juice samples contained the same isolates as recovered in the lower respiratory tract by PFGE analysis. Conclusions Mechanical ventilation in RICU and NICU was a high risk factor for VAP development. Special emphasis of VAP prophylaxis should be paid on subglottic secretion and gastric juice reflux.
文摘目的比较支气管哮喘患儿在肺通气和脉冲振荡两种方法学检测的支气管舒张试验(bronchodilation test,BDT)中各参数敏感性与相关性。方法根据纳入及排除标准,选取157例哮喘患儿完成肺通气功能、脉冲振荡检查及舒张试验。按肺通气功能检查舒张试验中第1秒用力肺活量(forced expiratory volume in one second,FEV 1)改善率数值,将所有患儿分为四组,研究此两种方法学舒张试验前、后各气道参数的敏感性与各气道参数改善率之间的相关性。结果两种肺功能检查方法的舒张试验主要参数结果:四组FEV 1改善率分别为(2.94±1.54)%、(8.59±1.52)%、(15.25±2.06)%、(31.01±11.86)%,对应的呼吸总阻抗(respiratory impedance,Zrs)改善率分别为(10.83±6.71)%、(20.11±9.01)%、(27.06±10.67)%、(30.52±13.93)%,气道总阻力(respiratory resistance at 5 Hz,R5)改善率分别为(10.37±6.91)%、(18.25±7.60)%、(26.14±10.56)%、(29.05±13.56)%,外周弹性阻力(respiratory reactance at 5 Hz,X5)改善率分别为(17.36±26.60)%、(28.12±19.67)%、(36.19±17.36)%、(41.19±19.58)%;舒张试验后FEV 1与Zrs、R5、X5的相关性r值分别为0.499、0.478、0.386,存在不同程度的正相关性。结论舒张试验中,哮喘患儿的小气道参数与X5敏感性较高;脉冲振荡Zrs、R5、X5与肺通气FEV 1的改善率数值呈正相关性,脉冲振荡舒张试验中Zrs、R5、X5改善率作为衡量与推断结果的参数特异性更高,而在小气道方面,脉冲振荡R5更倾向反映总体情况。
