呼吸机相关性肺炎临床特点和病原菌耐药性分析

目的探讨呼吸机相关性肺炎临床特点和病原菌耐药现状,以便为呼吸机相关性肺炎的防治制定临床干预措施。方法采用回顾性分析的方法对2008年1月～2011年10月在某院住院治疗的呼吸机相关性肺炎与随机抽取的使用呼吸机但是出现呼吸机相关性肺炎的各30例患者的临床资料进行整理和分析。结果多因素Logistic回归分析结果表明,年龄、严重躯体疾病、气管插管时间、气管切开、长期使用广谱抗生素、开放式吸痰及患者体位(床头角度)﹤30°是发生呼吸机相关性肺炎的危险因素,从呼吸机相关性肺炎患者分离到的病原菌以鲍氏不动杆菌为主,占37.21%,对氨苄西林耐药的占67.44%,而对亚胺培南、两性霉素B及制霉菌素敏感。结论呼吸机相关性肺炎发生受多种因素影响,由多种高危因素引起,应就患者自身的危险因素采取针对性的预防措施,在抗生素的选择上以抗G-菌敏感为主的抗生素,为该类患者制定更为适合的治疗方案,减少患者的死亡率,改善患者的预后,提高患者的生活质量。

Clinical characteristics and pathogen resistance of ventilator-associated pneumonia

OBJECTIVE To investigate clinical features,pathogen distribution and drug resistance situation of ventilator-associated pneumonia,in order to have a more in-depth understanding of ventilator-associated pneumonia,then to guide the treatment of it.METHODS We collected clinical data of 30 cases of ventilator-associated pneumonia and patients using a breathing machine without ventilator-associated pneumonia who were treated in the department of respiration in our hospital from January 2008 to October 2011.Then analyzed clinical features,pathogen distribution and drug resistance situation between two groups.RESULTS Multivariate Logistic analysis indicated that age,severe systematic diseases,intubation time,tracheotomy,long-term use of broad-spectrum antibiotics,open suction and position of the patient(bed angle)﹤30° had a risk effect on ventilator-associated pneumonia.Most of pathogens from ventilator-associated pneumonia isolated from patients was acinetobacter bacilli(37.21%).The drug resistance rate of pathogenic bacteria to ampicillin was 67.44%.Pathogenic bacteria were sensitive to imipenem,amphotericin B and fungicidin.CONCLUSION Ventilator-associated pneumonia is affected by many factors,we should take appropriate preventive measures according to the patient’s own risk factors and choose antibiotics sensitive to negative bacilli for a more appropriate treatment for them to reduce mortality in patients and improve the quality of life.