医院内获得性肺炎84例临床分析

目的：为了解呼吸监护病区医院内获得性肺炎（院内肺炎）的临床特点。方法：对84例院内肺炎进行回顾性分析。结果：其发病率为5.8％。有83.3％（70／84）的患者于入院1周后发病。常见的情况为抗菌药物不合理使用，占94％（79／84），皮质激素不合理应用，占17.9％（15／84），气管插管或气管切开机械通气，占17.9％（15／84）及胸腹部手术后，占8.3％（7／84）。33.3％有发热，72.6％有咳嗽咳痰增多，56％有呼吸困难，全部患者均有肺部罗音。痰培养细菌检出率为96.4％，分离革兰氏阴性（G-）菌54株（66.7％），革兰氏阳性（G＋）菌22株（27.2％），真菌5株（6.2％），药敏试验显示病原菌对各种抗菌药物有不同程度的耐药。病死率为22.6％。结论：院内肺炎患者往往有严重的基础疾病，且全身情况差，以及多脏器功能衰竭等合并症存在，使临床表现不典型，应引起足够重视，才能及时诊断和治疗。

Hospital Acquired Pneumonia:A Clinical Study of 84 Cases

To understanding the character of hospital acqurired pneumonia (HAP) in ICU and respiratory ward. Methods: 84 cases of HAP were investigated. Results: Morbidity rate were 64. 3% (54/84) in respiratory ward and 33.7% (30/84) in ICU. 83. 3% of HAP were occurring in one week after admission. All the patients of HAP had presence comorbid illnesses,the most related risk was inappropriately used of antibiotocs [94% (79/84)]. 17. 9% (15/84 ) were caused corticosteroid and intubed or mechanical ventilation and 8. 3% after thoraci abdornen operation. Symptoms: Fever 33. 3 %, increasing cough and sputum 72. 6 %, dyspnea 56. 0%,100.0% had breathing rales. Sputum culture: Isolated positive rate was 96. 4%, among them Gram negative bacllli were 66. 7 % Gram positive 27. 2%, and Fungi 6. 2%. Total morbidity mortality was 22. 6 %, main death causes were respiratory failure, MOF and septic shock. Due to the complicated conditions clinicians should pay great attention to HAP.