气囊上滞留物与呼吸机相关肺炎的相关性研究

目的探讨气囊上滞留物与呼吸机相关肺炎(VAP)的关系。方法对33例呼吸重症监护病房(RICU)的机械通气患者,分别于插管后48h、7d及14d同步行咽拭子、气囊上滞留物、下呼吸道细菌分泌物定量培养和药敏试验。结果VAP的发病率为48·5%,病死率为37·5%;VAP组下呼吸道分泌物培养主要优势菌为铜绿假单胞和鲍曼不动杆菌;VAP患者气囊上滞留物与下呼吸道优势菌符合率为62·5%,且随着机械通气时间的延长,气囊上滞留物、下呼吸道分泌物细菌的株数逐渐增多。结论RICU中VAP患者相关部位(气囊上滞留物、下呼吸道分泌物、咽拭子)优势菌以G-杆菌为主;气囊上滞留物优势菌与VAP的下呼吸道分泌物致病菌具有较高的一致性,提示气囊上滞留物病原菌的移行是导致VAP的重要原因之一。

The study on the association of subglottic secretion with ventilator-associated pneumonia

Objective To assess the relation of peri-cuff subglottic secretion to ventilator-associated pneumonia (VAP) in intubated patients in respirastory intensive care unit (RICU).Methods Pharygeal brush,peri-cuff secretions and lower airway secretions by bagpipe protected specimen brush were sampled at 48 h,on 7 d,14 d after intubation.Bacterial quantitative culture and antibiotic sensitivity test were taken in 40 minutes. Results The prevalence of VAP was 48.5% and the mortality was 37.5%.The dominant bacteria cultured in the lower airway secretion of VAP patients were pseudomones aeruginosa and Baumanii Acinetobatter.In 62.5% specimens bacteria culture found the same dominant strains in the subglottic secretions and the lower airway respiratory tract secretions.The longer the ventilation duration the more strains the culture yielded.ConclusionsThe dominent bacteria in the subglottic secretion and the lower airway respiratory related to VAP in RICU are Gram negative bacilli.The similarity of dominant bacteria in subglottic secretion and lower airways suggests a possible bacterail origin which translocate from upper airway to lower respiratory tract and may contributes to the occurrence of VAP.