新生儿呼吸机相关肺炎的危险因素与病原菌研究

目的探讨新生儿机械通气相关肺炎(VAP)的危险因素及病原菌.方法选取新生儿机械通气时间≥48h患儿180例,符合VAP诊断标准73例作为VAP感染组,VAP未感染组作为时照组,采用单因素分析VAP的危险因素;并对VAP作病原菌分析.结果VAP发生率40.56%.单因素分析表明低体重儿及早产儿,机械通气时间＞5d,肺部原有疾病、有胃内容物吸入、鼻饲、使用胃酸抑制剂/抗酸剂是VAP的危险因素,而机械通气时患儿头部位置抬高＞30°及大剂量静脉注射丙种球蛋白能预防VAP的发生;预防性使用抗生素不能降低VAP的发生.病原学以G-菌为主,但G+菌发生率显著上升,前5位依次为克雷白菌属、铜绿假单胞杆菌、金葡菌、肠杆菌属、不动杆菌属.结论避免VAP的危险因素,使用大剂量静脉注射丙种球蛋白能降低VAP的发生率.

Analysis of the risk factors and microbial causes for ventilator-associated pneumonia in newborns

ve To investigate the risk factors and microbial causes related to the development of ventilator- associated pneumonia(VAP). Methods A total of 180 intubated newborns for longer than 48 hours in Yuying Pediatrics Hospital were studied and divided into VAP group(73 cases) and non VAP group. Microbial causes of VAP were analyzed. Results The incidence of VAP was 40. 56%. Premature birth and low-birth-weight over 5 days ventilation,primary pulmonary diseases, enteral feeding, H2 receptor antiagonist and antacids were independently factors of VAP. It is useful for preventing VAP to the head of the baby and use a large dose of intravenous immunoglobulin. Preventive antimicrobial usage can not decrease the morbidity of VAP. The most frequently isolated organisms were Klebsiella species, Pseudomonas aeruginosa, Staphylococcus aureus,Enterobacteriaceae,Acinetobacter species. Conclusions It is suggested that a large dose of intravenous immunoglobulins might be useful in both preventing and treating VAP.