老年人呼吸机相关肺炎的危险因素及耐药性分析

目的：研究老年人呼吸机相关肺炎的危险因素以及耐药性。方法选取2012年4月至2014年4月ICU老年呼吸机相关肺炎（ VAP）患者160例的临床资料，分析VAP发生与年龄、机械通气时间、是否行气管切开以及原有疾病的关系，并进行药敏实验对耐药性进行统计。结果原有慢性阻塞性肺疾病、机械通气时间超过7 d、年龄超过65岁患者VAP发病率（16．8％、13．4％、18．5％）均显著增加（χ2＝11．592、11．989、13.187，均P＜0．05），切开气管VAP的发生机会并不增加（P＞0．05）。老年VAP感染的主要病原菌铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌，药敏实验发现患者存在多重耐药性，耐药性依次为氨苄西林、哌拉西林、环丙沙星、氧氟沙星以及头孢曲松。结论原有慢性的肺部疾病、机械通气时间过长以及年龄超过65岁是老年人VAP的危险因素，患者存在多重耐药，以氨苄西林耐药最多。

Risk factors and drug resistance of elderly patients with ventilator associated pneumonia

Objective To investigate the risk factors and drug resistance in elderly patients with ventilator associated pneumonia（VAP）.Methods From April 2012 to April 2014,the clinical data of 160 senile VAP patients in ICU were selected,the relationship of VAP with age,duration of mechanical ventilation,whether tracheotomy and the original diseases were analyzed .The drug susceptibility test was made to analyze the drug resistance .Results The incidence rates of VAP in patients with chronic obstructive pulmonary disease ,duration of mechanical ventilation more than 7d,over 65 years old （16.8%,13.4%,18.5%） were significantly increased （χ2 =11.592,11.989,13.187,all P〈0.05）,the incidence rate of VAP did not increase in the tracheotomy （P〉0.05）.The main pathogenic bacteria in elderly patients with VAP infection were Pseudomonas aeruginosa , Klebsiella pneumoniae , Escherichia coli , Enter-obacter cloacae .Drug sensitive experiment found that patients had multi-drug resistance ,the strains had higher resist-ance rate to ampicillin,piperacillin,ciprofloxacin,ofloxacin and ceftriaxone .Conclusion The original chronic lung disease,mechanical ventilation time and over 65 years old are risk factors of elderly VAP ,the patients have multi-drug resistance ,and the strains show the highest resistance to ampicillin .