外科ICU呼吸机相关肺炎的调查研究

目的　了解外科重症监护室 (SICU)内呼吸机相关肺炎 (VAP)的流行病学和细菌耐药情况 ,为临床防治提供依据。方法　对近 3年内有完整细菌学资料的VAP患者 6 8例进行回顾性分析。结果　 6 8例中发现早发VAP病例 2 3例和迟发VAP病例 4 5例 ,共分离出G- 杆菌 5 5株、G+ 球菌 32株和真菌 2 2株。早发VAP患者G+ 球菌感染率较迟发VAP患者高 (P <0 .0 5 ) ,以金黄色葡萄球菌为主 ;迟发VAP患者G- 杆菌感染率及真菌感染率较早发VAP患者高 ,(分别为 P <0 .0 0 1和 P <0 .0 5 ) ,且菌种的多样性明显 ,不动杆菌成为主要致病菌。复合细菌感染 19例 ,迟发VAP患者感染率亦较早发VAP患者高 (P <0 .0 5 )。细菌的耐药性较强。结论　SICU内提倡按VAP发生的时间来选择经验性抗生素治疗 ,迟发VAP氟康唑预防性抗真菌治疗应更积极些。

Investigation and analysis on ventilator-associated pneumonia in surgeon ICU

Objective To investigate the epidemiology and the state of drug resistance for ventilator-associated pneumonia (VAP)in surgeon ICU.Methods The data about bacteriology in 68 patients with VAP collected in last 3 years were analyzed retrospectively.Results Among 68 patients, there were 23 patients with early-onset VAP and 45 patients with late-onset VAP.The 55 strains of gram-negative bacilli,32 strains of gram-positive cocci and 22 strains of fungi were isolated. The infection rate of gram-positive cocci in early-onset VAP was significantly higher than that of late-onset VAP(P<0.05), and the main strain was staphylococcus aureus, however, the infection rate of gram-negative bacilli and fungi in late-onset VAP was significantly higher than that of early-onset VAP (P<0.001 or P<0.05),which was mainly amotile bacilli. The multiple bacteria infection was found in 19 patients, and the infection rate of late-onset VAP was obviously higher than that of early-onset VAP (P<0.05).The drug resistance of most bacteria was greater.Conclusion It is a good way to choose antibiotics according to the onset time of VAP. The fluconazole is effective for the preventive treatment of fungi infection in patients with late-onset VAP.