呼吸机相关性肺炎病原菌分布及危险因素分析

目的 探讨重症监护病房(ICU)老年患者呼吸机相关性肺炎(VAP)病原菌分布及危险因素,为防治老年患者VAP提供科学依据.方法 选择安徽中医药大学第一附属医院2013年 10月至2015年 12 月ICU收治的机械通气48 h以上的80例患者,36例患者发生VAP(VAP组),44例患者未发生VAP(非VAP组),分析VAP患者病原菌分布及相关危险因素.结果 VAP主要致病菌依次为鲍曼不动杆菌(26.0%)、肺炎克雷伯菌(16.0%)、金黄色葡萄球菌(16.0%)、铜绿假单胞菌(10.0%)、溶血葡萄球菌(8.0%)等.两组患者在机械通气≥5 d、APACHE Ⅱ评分≥15 分、意识障碍、误吸、留置胃管、营养状况、抑酸剂、抗菌药物的联合应用方面的差异有统计学意义(P<0.05);多因素logistic回归分析显示其中机械通气时间≥5 d、误吸、意识障碍、抗菌药物联合应用是发生VAP独立危险因素.结论 VAP主要致病菌为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌等,VAP的危险因素有机械通气时间≥5 d、误吸、意识障碍、抗菌药物联合应用等.

Analysis on pathogenic bacteria distribution and risk factors of patients with ventilator associated pneumonia

Objective To discuss the pathogenic bacteria distribution and risk factors of ventilator associated pneumonia (VAP) of elderly patients in intensive care unit (ICU), for providing the scientific basis of the prevention and control of ventilator associated pneumonia.Methods The clinical data of 80 patients with mechanical ventilation more than 48h in ICU were collected. 36 cases with VAP were divided in VAP group,while the others were in no-VAP group.The pathogenic bacteria distribution and risk factors of VAP were discussed. Results The common pathogenic bacteriaof VAP was acinetobacter baumannii(26.0%),klebsiella pneumoniae(16.0%),staphylococcus aureus(16.0%), pseudomonas aeruginosa(10.0%), hemolytic staphylococci(8.0%)in the order. Compared with the no-VAP group, the mechanical ventilation time, APACHE Ⅱ score, disturbance of consciousness, aspiration, indwelling gastric tube, nutritional status, antacid, the combined application of antibiotics, showed significant difference in the VAP group(P<0.05). According to multiple factors regression analysis, the mechanical ventilation time ≥5d, aspiration, disturbance consciousness, and the combined application of antibiotics were indicated to be the independent risk factors of VAP.Conclusion The common pathogenic bacteriaof VAPare acinetobacter baumannii, klebsiella pneumoniae, pseudomonas aeruginosa,and so on.The risk factors of VAP are the mechanical ventilation time ≥5d, aspiration, disturbance of consciousness, combined application of antibiotics, etc.