肺外科术后呼吸机相关肺炎临床分析

目的研究肺外科术后呼吸机相关肺炎(VAP)的临床特点。方法 2003年1月至2005年3月我院收治的肺外科术后机械通气患者104例中,同时符合 VAP 和术后肺炎(POP)诊断者35例,无肺炎临床证据的41例。分析76例患者的临床和实验室资料。结果术后 VAP 临床诊断35例(46.1%),病原学诊断33例。术后 VAP 患者手术距离插管天数(2.7±2.9)d vs.(1.6±1.7)d,P=0.039]、机械通气时间(32.2±37.7)d vs.(4.2±2.9)d,P<0.001]和病死率(20.0%vs.2.4%,P=0.013)明显高于没有术后 VAP 的患者。15例早发性和20例迟发性术后 VAP 患者在机械通气时间上差异有统计学意义(17±15)d vs.(43±46)d,P=0.042]。分析首次检测到的病原菌,革兰阳性菌仍以金黄色葡萄球菌最多见,鲍曼不动杆菌取代铜绿假单胞菌而居革兰阴性菌之首。结论肺外科术后 VAP 有不同于内科 VAP 的临床特点。

The clinical features of postoperative ventilator-associated pneumonia after lung surgery

OBJECTIVE: To investigate the clinical features of postoperative ventilator-associated pneumonia (VAP) after lung surgery. METHODS: Of 104 patients who had undergone lung surgery and been treated with ventilator in our surgical intensive care unit between January 2003 and March 2005, 35 patients met with the criteria of both VAP and postoperative pneumonia (POP), and 41 cases had no evidences of pneumonia. The clinical and laboratory data of all 76 cases were recorded and analyzed by a statistical software package (SPSS). RESULTS: The diagnosis of postoperative VAP was established clinically in 35 patients (46.1%), and etiologically in 33 cases. Compared to the patients without postoperative VAP, the patients with postoperative VAP had a significantly longer mean interval between intubation and operation (2.7 +/- 2.9) days vs. (1.6 +/- 1.7) days, P = 0.039], a longer duration of mechanical ventilation (32.2 +/- 37.7) days vs. (4.2 +/- 2.9) days, P < 0.001], and higher morbidity (20.0% vs. 2.4%, P = 0.013). There was a significant difference in mean duration of mechanical ventilation between the 15 cases of early-onset VAP and 20 cases of late-onset VAP (17 +/- 15 days vs. 43 +/- 46 days, P = 0.042). Among the initially detected pathogen, Staphylococcus aureus remains the most common Gram-positive coccus whereas Acinetobacter Baumannii took the place of Pseudomonas aeruginosa as the top Gram-negative rod. CONCLUSION: Postoperative VAP after lung surgery has different clinical features from VAP in medical ICU.