2009～2011年呼吸机相关性肺炎目标性监测分析

目的分析呼吸机相关性肺炎(VAP)的发生率、病原菌特点及发病危险因素,制订有效的预防控制措施。方法对2009～2011年1317例机械通气住院患者进行目标性监测,对确诊呼吸机相关性肺炎患者的病原菌进行监测和药敏学分析,并单因素分析VAP发生的危险因素。结果发生VAP 113例,发生率为8.5%,检出病原菌119株,其中革兰阴性杆菌69株,占57.98%;革兰阳性球菌37株,占26.05%;真菌19株,占15.97%;主要病原菌分别为肺炎克雷伯菌、洋葱伯克霍尔德菌、铜绿假单胞菌、阴沟肠杆菌、鲍曼不动杆菌,分别占12.88%、9.85%、9.09%、6.06%、5.30%;呼吸机使用时间≥7天、昏迷、留置胃管、应用制酸药物、联用抗菌药、气管导管气囊无定时测压是VAP发生的危险因素(P<0.05)。结论 VAP发生的高危因素甚多,通过目标性监测能够对病原菌与危险因素及时进行分析评价,争取有效干预措施,进一步降低VAP的发生率。

Target surveillance of ventilator-associated pneumonia in inpatients during 2009-2011

Objective To analyze the infection rate,the character of pathogen and the risk factor of ventilator-associated pneumonia(VAP),take effective control countermeasures to reduce it.Methods From 2009 to 2011,objective surveillance of 1317 inpatients who were used mechanical ventilation were monitored,bacterial culture and antibiotics sensitive among the inpatients who were diagnosed as ventilator-associated pneumonia(VAP) were monitored and tested too.Analyzes the risk factor of VAP.Results There were 113 inpatients developed pneumonia,the incidence was 8.5%.119 strains of bacteria were collected,which included 69(57.98%) strains of gram-negative bacteria,37(26.05%) strains of gram-positive bacteria and 19 strains of fungi(15.97%),Klebsiella pneumonia(12.88%),Burkhilderia cenocepacia(9.85%),Psendomonas aernginosa(9.09%),Enterobacter cloacae(6.06%),Acinetobater baumannii(5.30%) were the five more common isolates among gram-negative bacteria.The risk factors associated with VAP were the mechanical ventilation over 7 days,coma,indwelling nasogastric tube,use of acid inhibitor,the combination of both antibiotics,tracheal catheter balloon irregular pressure.Conclusions There are many risk factors in ventilator-associated pneumonia.Through the objective surveillance pathogen,the risk factor of VAP can be monitored and evaluated in time.We can take effective interventions to reduce the incidence of neonatal ventilator-associated pneumonia.