老年人呼吸机相关性肺炎的危险因素及病原学分析

目的研究老年人呼吸机相关性肺炎（VAP）的病原学和预后情况。方法选择老年科行呼吸机治疗的患者92例，采用回顾性队列研究方法，分析临床资料、病原菌构成、耐药性情况。结果VAP组和无VAP组之间的性别、呼吸末正压，是否服用H：受体阻滞剂、利尿剂、糖皮质激素，是否经口气管插管，是否气管插管后改气管切开等情况均差异无统计学意义（P〉0．05）；而两组患者的年龄、慢性阻塞性肺疾病（COPD）病程、白蛋白、机械通气时间、抗生素连续使用情况、是否昏迷等方面均差异有统计学意义（P〈0．05）。VAP患者的呼吸道分泌物培养分离出109株细菌，其中革兰阴性茵74株（67．89％），革兰阳性茵22株（20．18％），真茵13株（11．93％）。氨苄青霉素和头孢唑林对铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌及葡萄球菌属的耐药率较高，在70％-100％之间；而庆大霉素和丁胺卡那霉素对以上病原菌的耐药率较低，在19％-42％之间；泰能对以上病原菌的耐药率更低，在5％～22％之间。结论年龄、COPD病程、白蛋白、机械通气时间、抗生素连续使用天数、抗生素舍用种类、是否气管切开及是否昏迷均是发生VAP的危险因素，革兰阴性菌是VAP的主要病原茵，合理应用抗生素对VAP具有重要的防治意义。

Analysis for Risk Factors and Etiology of Senile Ventilator- Associated Pneumonia

Objective To analyze the risk factors and etiology of senile ventilator-associated pneumonia（VAP）. Methods 92 patients with ventilator treatment were selected and their clinical data,pathogenic bacterial constituent and drug resistance were analyzed by the retrospective cohort study methods. Results There were no statistical differences in gender,positive end expiratory pressure（PEEP）,tak- ing H2 receptor blockers,diuretics and glucocortieoid,oral trachea cannula or traeheotomy after trachea eannula between the VAP group and the non - VAP group（ P 〉 0.05）. But the age, COPD course, albumin, duration of mechanical ventilation, antibiotic continuous use and coma had statistical differences between the VAP group and the non-VAP group（ P 〈 0. 05）. The respiratory secretions in the pa- tients with VAP were send for culture. 109 strains of bacteria were isolated,among which,74 strains（67.89% ） were Gram-negative bacteria,22 strains（20. 18% ） were Gram- positive bacteria and 13 strains （11.93%） were fungi. Pseudoulonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli and Staphylococcus had the high resistance rates（70%- 100% ） to ampicillin and ce- fazolin;Pseudomonas aeruginosa,Acinetobaeter baumannii, Klebsiella pneumoniae,Eseherichia coil and Staphylococcus had the lower resis- tance rates （19% -42% ） to gentamicin and amikacin;which to imipenem was lowest （5% -22% ）. Conclusion Age,COPD course,al- bumin,duration of mechanical ventilation,antibiotic continuous use days,antibiotics combination,traeheotomy and coma are the risks of VAP occurrence. Gram- negative bacteria are the main pathogens of VAP. Rational use of antibacterial drugs has important significance to prevent and treat VAP.