重症监护病房呼吸机相关性肺炎的临床研究

目的 探讨重症监护病房(ICU)中呼吸机相关性肺炎(VAP)的病原菌组成及相关因素,为临床防治提供依据. 方法 分析137例ICU内确诊的VAP患者的临床资料及下呼吸道分泌物细菌培养的结果 .结果 VAP的发生率为53.10%;137例患者共检出334株致病菌,其中革兰阴性菌208株(62.28%),革兰阳性菌55株(16.47%),真菌71株(21.25%);铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷白菌和白色假丝酵母菌是VAP的主要致病菌;药敏结果 显示感染菌株多重耐药,肠杆菌科革兰阴性菌对碳青霉烯类抗生素无一耐药,非发酵菌革兰阴性菌对常用的抗生素均具有较高的耐药性,革兰阳性菌对万古霉素无一耐药. 结论 ICU内VAP病原菌以革兰阴性菌为主,真菌比例较高,混合致病菌感染比例高;积极预防和治疗可以有效降低VAP的发生.

The clinical research on ventilator-associated pneumonia in intensive care unit

Objective To explore the of pathogens leading to ventilator-associated pneumonia in intensive care unit so as to provide evidences for clinical therapy. Methods the clinical data and the results of bacteria culture from the secretion of lower respiratory tracts of 137 patients suffering from VAP in ICU were analyzed. Results the VAP incidence rate was 53.10%. 334 stains of pathogens were separated from 137 patients. In these pathogens, there were 208 strains of gram negative bacteria, 55 of gram positive bacteria and 71 of fungi. The main pathogens of VAP included pseudomonas aeruginosa, staphylococcus, klebsiella pneumoniae, aureus. Susceptibility test results showed that most pathogens were multi-drug resistant. No enterobacteriaceae had drug-resistance to carbopenems. Nonfermenters had a high drug-resistance to many widely-used antibiotics. Gram positive bacteria had no drug-resistance to vancomysin. Conclusions The main pathogens of VAP in ICU were gram negative bacteria. The rate of fungus and multiple bacterial infections was high. The combined treatment is necessary constitution for control of VAP.