外科重症监护病房呼吸机相关肺炎病原学与临床分析

目的 了解外科重症监护病房（ICU）呼吸机相关肺炎（VAP）发生率、病死率、病原菌分布情况。方法 回顾分析2000年1月-2003年12月外科ICU收治的105例VAP患者的临床资料、病原菌构成以及药敏结果。结果 105例机械通气患者，其中43例发生VAP，VAP发生率为44．7％，病死率为35％。共分离出病原菌株227株、细菌164株，占72．55％。真菌63株，占27．45％，革兰氏阴性杆菌为66％，铜绿假单胞菌、肺炎克雷白氏、黄杆菌及大肠埃希氏菌，革兰氏阳性菌为34％。以金黄色葡萄球菌为主。结论 革兰氏阴性杆菌是外科重症监护病房呼吸机并发肺部感染的主要致病菌，临床医师可根据药敏试验合理使用抗生素。

Pathogenic and clinical analysis of ventilator associated pneumonia in surgical intensive care unit

Objective To investigate the occurrence rate, mortality and distribution of pathogens of ventilator associated pneumonia(VAP) in surgical intensive care unit(ICU). Methods Clinical data of 105 patients with ventilator therapy were retrospectively analyzed, including changes in bacteria strains, drug resistance and treatment effects. Results Out of 105 patients, 43 patients had VAP, and the rate of VAP was 44.7%. A total of 227 pathogen strains were isolated, out of them, gram-positive cocci and gram-negative bacilli accounted for 72.55%(164/227), fungicidal accounted for 27.45%(63/227), and most of them were gram-negative bacilli, including P.aeruginosa, klebsiella spp and E.coli. The important gram-positive coccus was S.aureus. Conclusion Gram-negative bacilli are the major pathogens of VAP in surgical ICU. In order to control drug resistance, reasonable application of antibiotics should be emphasized.