重症监护患者并发呼吸机相关肺炎临床与病原学分析

目的:探讨机械通气后发生呼吸机相关性肺炎(VAP)的临床及病原学特点,为治疗提供依据。方法:观察38例VAP的临床症状;并通过气管分泌物培养及药物敏感试验,分析培养结果的致病微生物及耐药率。结果:38例VAP患者34例细菌检查呈阳性,共检出病原菌株40株,其中革兰阴性菌24株(60%),革兰阳性球菌11株(27.5%),真菌5例(12.5%)。治疗有效26例(68%),无效12例(32%)。结论:病原菌以革兰阴性菌感染为主,呈多重耐药。往往几个因素同时存在,尽早选用有针对性的抗生素,采用降阶梯治疗策略,获得药物敏感试验后,选择敏感抗生素,可收到较好的疗效。

Analyse the clinic and pathogeny on the patients with intercurrent VAP in intensive care unit

Objective:To explore the clinical and pathogenic features on V AP which is caused after the Mechanical ventilation,to provide the gist for treat ment.Methods:observe the clinical symptom on38cases of VAP;Through the culture o f trachea secretion and antibiotic sensation test,analysis the culture result o f pathogenic microorganism and Drug Resistance Rate.Results:Of totally38VAP pati ents,the culture result of34cases was positive.40strains of pathogenic bacteria were detected.Among these,24strains(60%)were Gram positive while11strains(2 7.5%)were Gram negative,and5strains(12.5%)belonged to epiphyte.After treatme nt,26cases(68%)were effective whereas12cases(32%)were not effective.Conclus ion:Most pathogenic bacteria were Gram negative and of multiple drug resistance. VAP are always resulted by several fac-tors,and the relation among these facto rs are complicated.Integrated prevention steps were advised to take for the trea tment of VAP,and specific antibiotic should be used as soon as possible.De-esca lation therapy strategy was applied in the treatment of VAP.Choosing the sensiti ve antibiotic after antibiotic sensation test,the effect of the treatment is qu ite satisfacting.