52例ICU呼吸机相关性肺炎危险因素及病原学分析

目的 探讨ICU呼吸机相关性肺炎(VAP)的危险因素、病原菌分布及耐药性.方法 回顾性分析医院呼吸科重症监护病房和外科重症监护病房2010年5月-2011年8月收治的进行机械通气138例患者临床资料,并对所有患者进行APACHEⅡ评分和CPIS评分.结果 单因素分析表明,气管切开、昏迷、住ICU≥5d、机械通气≥4 d、使用镇静剂、使用激素、留置胃管与VAP相关,logistic回归分析显示,住ICU≥5d、留置胃管和昏迷是发生VAP的独立危险因素；VAP组APACHEⅡ评分(21.8±7.4)明显高于非VAP组(14.5±4.8),差异有统计学意义(P＜0.05),两组间CPIS评分比较差异无统计学意义；52例VAP患者中共分离出164株病原菌,其中革兰阴性菌104株占63.4％,革兰阳性菌35株占21.3％,真菌25株占15.2％,鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌是VAP的主要致病菌.结论 住ICU≥5d、留置胃管和昏迷是发生VAP的危险因素,APACHEⅡ评分可作为预测VAP感染的指标,导致VAP的各种病原菌普遍耐药性较强.

Risk factor and pathogen analysis in 52 cases of ventilator-associated pneumonia in intensive care unit

OBJECTIVE To investigate the risk factors,pathogen distribution as well as the drug susceptibility associated with VAP.METHODS Clinical data of 138 mechanically ventilated patients admitted to the respiratory ICU or surgical ICU in Chinese PLA General Hospital from May 2010 to Aug 2011 were retrospectively analyzed.These data were evaluated in APACHEII score system and CPIS score system.RESULTS There were several factors associated with VAP including tracheotomy,coma,duration in ICU≥5 days,more than 4 days of mechanical ventilation,use of sedatives,use of steroids and detaining gastric tube.Logistic analysis showed that duration in ICU≥5 days,coma and detaining gastric tube were risk factors of VAP.The average APACHEII score in the VAP group(21.8±7.4)was significantly higher than the non-VAP group(14.5±4.8)(P<0.05),while no significant difference was found in the CPIS score between two groups.164 pathogens were isolated in 52 patients with VAP,including 104 gram-negative bacteria(3.4%),35 gram-positive bacteria(1.3%) and 25 fungi(15.2%).The major pathogens of VAP were Acinetobacter baumannii,Pseudomonas aeruginosa and Staphylococcus aureus,all of which had high drug resistance rate.CONCLUSION The ICU stay more than 5 days,gastric intubation,and coma are the risk factors for VAP.APACHEII can serve as an indicator for the prediction of VAP infeciton;the drug resistance of the pathogens causing VAP is generally serious.