摘要
目的分析重症监护病房中引起呼吸机相关性肺炎（VAP）的危险因素及常见病原菌的种类分布、耐药性。方法回顾性分析220例采用机械通气治疗患者的临床资料，按照是否发生VAP分为观察组（88例，并发VAP）和对照组（132例，未并发VAP），探讨引起VAP的危险因素；对观察组患者的呼吸道分泌物进行细菌培养及药敏试验，分析病原菌种类及其耐药性。结果VAP相关危险因素分析及多因素Logistic回归分析发现，COPD病史、有创机械通气、口咽部微生物定植阳性、不规范使用抗生素、年龄〉60岁、APACHEⅡ〉30分等为独立危险因素（均P〈0．01）。共分离出157株病原菌，革兰阴性菌（G-）108株（68．9％），革兰阳性菌（G＋）41株（26．1％），真菌8株（占5．0％）。G’菌中金黄色葡萄球菌均为产B内酰胺酶的耐甲氧西林葡萄球菌（MRSA），对头孢他啶、头孢哌酮、依替米星等抗生素的耐药率均为100．0％，仅有4株对左氧氟沙星敏感。G-菌对头孢吡肟、氨曲南的耐药性超过80％，而对亚胺培南及哌拉西林相对敏感。真菌中以白色念珠菌为主，耐药率较低，仅1株对氟康唑呈高度耐药。结论对存在发生VAP危险因素的行呼吸机治疗患者进行呼吸道病原菌及耐药率检测，对减低VAP的发生及指导临床合理用药具有重要意义。
Objective To study the risk factors for ventilator associated pneumonia （VAP） in ICU and pathogens antimicrobial resistance. Methods 220 patients were selected and divided into observation group （88 pa- tients） and control group（ 132 patients） depending on whetherhe has VAP or not. The clinical data were reviewed to explore the risk factors. And the secretions of respiratory tract were investigated by the routine bacterial culture and drag-resistance methods to analysis the distribution of pathogens. Results The risk factors associated with VAP were COPD, mechanical ventilation, the extensive use of antibiotics, age 〉 60 years, APACHEII score 〉 30 （ P 〈 0. O1 ）. 157 bacterial were cultured,68.9% of pathogens was Gram-negative bacteria in which Pseudomonas aeruginosa was rated as the top one, and 26.1% of pathogens was Gram-positive bacteria in which MRSA was the majority. The results of the antibiotic resistance monitoring indicated that all Gram-positive and Gram-negative bacteria showed high drug- resistance to common antibiotics. Conclusion We should control these risk factors which are closely related to VAP, and select suitable antibiotics on the basis of etiological analysis and drug-resistance.
出处
《中国基层医药》
CAS
2013年第3期331-333,共3页
Chinese Journal of Primary Medicine and Pharmacy
基金
基金项目：武警后勤学院附属医院种子基金课题（FYM201205）
关键词
肺炎
呼吸机
危险因素
机会致病菌感染
耐药性
细菌
Pneumonia, ventilator
Risk factors
Opportunistic.infections
Drug resistance, bacterial
