外科ICU机械通气患者医院内气管支气管炎发生率、病原学和危险因素分析

目的　探讨机械通气患者并发医院内气管支气管炎(NTB)的发生率、病原学及危险因素。方法　应用队列研究方法回顾性分析我院2002年1月—2004年4月在外科ICU内机械通气患者的临床资料。结果　96例外科ICU内机械通气患者有43例(44.8%)发生NTB,NTB组和非NTB组患者在血浆白蛋白、鼻饲情况、机械通气天数、抗生素应用种数以及ICU内住院时间差别均有统计学意义。鼻饲的比值比(OR)为4.5(95%CI为1.7~11.7),血浆白蛋白减低的OR值为2.6(95%CI1.2~6.0)。机械通气并发NTB患者第1位致病菌是鲍曼不动杆菌(39.5%),其次是金黄色葡萄球菌(32.6%)。在机械通气<5 d并发NTB患者常见致病菌是鲍曼不动杆菌和耐甲氧西林金黄色葡萄球菌(MRSA),机械通气≥5 d并发NTB患者常见致病微生物为铜绿假单胞菌和鲍曼不动杆菌。结论　ICU内机械通气患者NTB的发病率较高,血浆白蛋白减低、鼻饲、机械通气时间和ICU内住院时间延长是NTB的重要危险因素。NTB患者应合理使用抗生素,以减少细菌产生耐药。鲍曼不动杆菌、MRSA和铜绿假单胞菌是机械通气并发NTB常见致病菌。

Incidence, etiology and risk factors of nosocomial tracheobronchitis in surgical ICU patients with mechanical ventilation

Objective To analyze the incidence,pathogens and risk factors of nosocomial tracheobronchitis (NTB) in patients receiving mechanical ventilation (MV).Methods Retrospective cohort study was used to analyze the clinical data of patients with MV in surgical intensive care unit (ICU) from January 2002 to April 2004.Results Forty-three ( 44.8%) cases of NTB were diagnosed in 96 patients with MV in surgical ICU.The difference in serum albumin,nasal feeding,days of MV,the number of antibiotics used,and length of ICU stay between patients with and without NTB were statistically significant.The odds ratio (OR) of nasal feeding and lower albumin level were 4.5 (95%CI:1.7- 11.7) and 2.6 (95%CI:1.15-6.0) respectively.Acinetobacter baumannii (39.5%) was the most common pathogen in NTB,followed by Staphylococcus aureus (32.6%).A.baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were the most common pathogens in NTB patients who received MV for less than 5 days.However,Pseudomonas aeruginosa and A.baumannii were the most common microorganisms in those with MV for no less than 5 days.Conclusions High incidence of NTB was found in mechanically ventilated patients in surgical ICU.Lower albumin level,nasal feeding,prolonged MV and ICU stay were risk factors of NTB.Antibiotics should be appropriately used in NTB to decrease the emergence of resistant bacteria.A.baumannii,MRSA and P.aeruginosa were the most common pathogens of NTB in patients with MV.