儿童呼吸机相关肺炎的临床研究

目的:探讨儿童呼吸机相关肺炎(VAP)的临床特点及预防措施。方法:总结89例机械通气治疗患儿的临床资料,比较机械通气时间及是否预防性使用抗菌药物等因素与VAP发生率的关系;对病原学分析采用气道分泌物细菌培养及药物敏感试验进行分析。结果:有51例患儿发生VAP,发生率为57.3%。其主要病原菌为革兰阴性杆菌,占87.1%,其中以铜绿假单胞菌、肺炎克雷伯杆菌、大肠杆菌、不动杆菌为多见。VAP组上机时间明显长于非VAP组,预防性使用抗菌药物不能降低VAP的发生率。结论:VAP是机械通气治疗失败的重要原因之一,防治VAP应重视消毒和无菌操作以及合理使用抗菌药物,尽量缩短机械通气时间。

Ventilator associated pneumonia of childhood: A clinical study

Objective:To discuss the clinical characters,prevention and treatment of children with ventilator associated pneumonia(VAP).Methods:To summarize the clinical data in 51 children with VAP and compare the time of mechanical ventilation and antibiotic prophylaxis with the incidence rate of VAP,bacterial culture of airway secretion and drug sensitive test were used to analyze the etiology.Results:The incidence rate of VAP was 57.3%,respirator used time of VAP group was obviously longer than that of non VAP one.Antibiotic prophylaxis could not lower the incidence rate of VAP.Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter spp were the main pathogenic bacteria of VAP.Conclusion:VAP is one of the significant reasons for failed mechanical ventilation treatment.Prevention and treatment of VAP should pay attention to disinfection and aseptic manipulation,the rational use of antimicrobial agents,and shortening the time of mechanical ventilation.