呼吸机相关性肺炎25例临床分析

目的 分析呼吸机相关性肺炎（VAP）的临床及病原学特点,为防治VAP提供科学依据.方法 收集ICU行机械通气在48 h以上的病例68例中符合VAP诊断标准的25例病例,观察25例VAP的临床表现,并通过床边无菌吸痰技术吸取气道深部分泌物作培养及药物敏感实验.分析其临床特点,致病微生物药敏结果.结果 25例VAP患者细菌学检查呈阳性结果,共检出病原菌59株,其中革兰阴性杆菌共43株,居前三位的是鲍曼氏不动杆菌（25.4%）、肺炎克雷伯杆菌（17.0%）、阴沟肠杆菌（10.2%）.革兰阳性球菌共12株,以金黄色葡萄球菌居多,共10株.真菌4株.结论 革兰阴性菌为主是VAP的病原学特点,亚胺培南和美罗培南对革兰阴性菌有较高的药物敏感率.最初经验性抗菌治疗可采用“猛击”策略,在获得细菌培养结果之前,可直接选用强有力的抗生素,如碳青霉烯类抗生素.明确致病菌后,立即选用有针对性的、敏感的、相对窄谱的抗生素治疗.在抗菌治疗的同时,应进行合理的肠内营养,采用低糖高脂配方.此外,加强气道管理和感染控制教育也是防治VAP发生的重要手段.

Clinical analysis of ventilation-associated pneunomia In 25 cases

Objective] To analyze the clinical features and etiology character of ventilator-associated pneumonia(VAP) in order to provide the scientific evidence of preventing VAP. Mehthod] 25 cases who met the diagnosis criteria of VAP and were given mechanic ventilation over 48 hours in ICU were observed. Secretion cultivation in deep airway by bedside sterile sucking sputum and chemosensitivity were carried out. Clinical manifestation and pathogenic germ chemosensitivity were analyzed. Results] 59 germs were found in the 25 patients, in which 43 of Gram-negative germs were found, and the first three are Acinetobacter baumaunii(25.4%), Klebsiella pneumoniae(17.0%),Enteroobacter cloacae(10.2%);12 of Gram-positive germs were found in the 25 patients, 10 germs are staphylococcus; 4 fungi were found in the 25 patients. Conclusions] The main pathogenic germ is Gram-negative germ. Imipenem and Meropenem have the high chemosensitivity .So we can take "hitting hard" strategy of experimental therapy at first before obtaining the bacteria cultivation results, that is, using strong antibiotics such as Carbapenem antibiotics. Select sensitive and relative narrow spectrum antibiotics as soon as obtaining the result of pathogenic germs. At the same time, right eternal nutrition should be taken such as using low-glucose high-fat formula. In addition, another important method is to strengthen the airway management and preventing-infection education.