摘要
目的 了解ICU内呼吸机相关性肺炎(VAP)的致病菌分布特征及相关危险因素,以指导治疗及预防。方法 回顾性分析1999年1月～2001年1月ICU内收治的54例因非肺部感染而接受机械通气治疗后发生VAP的一般情况、病原菌培养及药敏和治疗转归。结果 54例患者共送检痰液标本165份,阳性结果157份,其中革兰阴性菌112份,占71.34％;革兰阳性菌30份,占19.11％;真菌15份,占9.55％。前5位病原菌依次为铜绿假单胞菌、鲍曼/溶血不动杆菌、肺炎克雷伯氏菌、金黄色葡萄球菌和表皮葡萄球菌。亚胺培南/西司他丁对革兰阴性菌的总体效果最好,哌拉西林/他唑巴坦、阿米卡星也有较好的疗效,头孢他定对铜绿假单胞菌的疗效优于其他抗生素;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)也呈明显上升趋势,占36％,其药敏以万古霉素最好,敏感率可达100％。结论 VAP的主要病原菌为革兰阴性菌,其耐药性明显增加;积极治疗原发病,尽量缩短机械通气时间,加强营养支持,合理选用抗生素,有助于治疗和预防VAP。
Objective To study the pathogenesis and the risk factors of ventilator-associated pneumonia in ICU to determine the prevention and treatment strategies.Methods Retrospective analysis was performed on general conditions, bacterial culture, antibiotics sensitivity results and treatment in 54 cases of ventilator-associated pneumonia in ICU.Results Various risk factors were revealed in these patients, included severe underlying disease, the defence impairement of the respiratory tract and gastroen-teral tract,bacteria translocation, the deterioration of nutrition, the prolonged mechanical ventilation, and iatrogenic infection, etc.Drug-resistant microorganisms were more common and more difficult to treat.Conclusion VAP is caused predominantly by Gram negative bacterium with multiple predisposing factors.The combination of multidiscinplary therapy is necessary for prophylaxis and treatment of VAP.
出处
《中国呼吸与危重监护杂志》
CAS
2002年第4期243-245,共3页
Chinese Journal of Respiratory and Critical Care Medicine
