摘要
目的分析新建综合性重症监护病房(ICU)的呼吸机相关性肺炎(VAP)病原菌分布和耐药特点以及高危因素,为临床治疗VAP提供科学依据。方法对2009-2011年入住罗定市人民医院新建综合性ICU的727例机械通气患者进行目标性监测,对确诊VAP患者的病原体进行鉴定和监测,并单因素分析VAP发生的危险因素。结果发生VAP共89例,发生率为12.24%,检出病原菌95株,其中革兰阴性菌66株(69.47%),革兰阳性球菌20株(21.05%),真菌9株(9.47%);主要病原菌分别为铜绿假单胞菌、洋葱伯克霍尔德菌、肺炎克雷伯杆菌、嗜麦芽寡养单胞菌、鲍曼不动杆菌,分别占16.84%、13.68%、10.53%、10.53%、6.32%;机械通气时间≥7d、昏迷、输血、留置胃管、气管导管气囊无定时测压、联用抗菌药、应用制酸药物均为VAP发生的危险因素。结论综合ICU的VAP发生的高危因素甚多,通过目标性监测能够及时对病原菌与危险因素进行分析,为临床治疗VAP提供科学依据。
Objective Analyze the character of pathogen and high risk factors in new comprehensive ICU, develop effective prevention and control measures for the clinical treatment of VAP. Methods From 2009 to 2011 ,objective surveillance of 727 inpatients who were admitted to our new comprehensive ICU and used mechanical ventilation were monitored, bacterial culture among the inpatients who were diagnosed as ventilator-associated pneumonia （VAP） were monitored and tested too. Analtyze the risk factor of YAP. Results There were 89 inpatients devdoped pneumonia, the incidence was 12.24%. 95 strains of bacteria were collected, which included 66 （69.47%） strains of gram-negative bacteria, 20 （21.05%） strains of gram-positive bacteria and 9 strains of fungi （9.47%）, Psendomonas aernginosa （16.84%）, Burkhilderia cenocepacia （ 13.68% ）, Klebsiella pneumonia （10.53%）, Stenotrophomonas maltophilia （ 10.53% ）, Acinetobater baumannii （6.32%） were the five more common isolates among gram-negative bacteria. The risk factors associated with VAP were the mechanical ventilation over 7 days, coma , blood transfusion,indwelling nasogastric tube, tracheal catheter balloon irregular pressure, the combination of both antibiotics, use of acid inhibitor. Couclusions There are many risk factors in ventilator-associated pneumonia. The rough the objective surveillance pathogen and the risk factor of VAP can be monitored and evaluated in time, to provide scientific basis for clinical treatment of VAP, thus we can reduce hospitalization and medical costs.
出处
《热带医学杂志》
CAS
2013年第7期809-812,共4页
Journal of Tropical Medicine
基金
云浮市医学科研课题(2009B028)
