重症监护病房呼吸机相关性肺炎危险因素与病原学分析

目的探讨重症监护病房（ICU）呼吸机相关性肺炎（VAP）的危险因素及病原菌的分布、耐药情况,为临床防治提供依据。方法以ICU内行机械通气的186例患者为分析对象,将其分为VAP组与非VAP组,对可能引起呼吸机相关性肺炎的危险因素进行比较分析;并分析VAP中的病原菌分布及耐药情况。结果 VAP发病与预防使用抗生素、抗生素应用种类、APACHEⅡ评分、机械通气时间、反复气管插管、胃内容物反流均有关（P〈0.05）;VAP共检出119株致病菌,其中革兰阴性菌87株,革兰阳性菌22株,真菌10株,其中非发酵菌是主要致病菌,耐药率极高,混合感染比例高。结论通过合理使用抗生素、减少机械通气时间、减少反流、减少反复气管插管可减少VAP的发生。VAP病原菌以革兰阴性菌为主,混合感染比例高,应积极防治,根据本地病原学和耐药性分析的指导下合理使用抗生素。

Analysis on Risk Factors and Etiology of Ventilator-associated Pneumonia in Intensive Care Unit

Objective To explore the risk factors,etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia(VAP) in intensive care unit so as to provide evidence for clinical prevention and treatment.Methods One hundred and eighty-six patients with mechanical ventilation in intensive care unit were enrolled in the study.All patients were divided into VAP group and non-VAP group,and then the risk factors for VAP were analyzed between the two groups.Etiological characteristics and bacterial susceptibility were also analyzed in VAP group.Results The incidence of VAP was related to prophylactic antibiotics,types of antibiotics,APACHE II scores,the duration of mechanical ventilation,re-intubation,and the contra-flow of gastric contents(P<0.05).119 strains of pathogenic bacteria were detected in VAP group,including 87 strains of Gram-negative bacteria,22 Gram-positive bacteria and 10 fungi.Non-zymophytes being the most common pathogens showed high resistant rates to commonly used antibiotics,and moreover,the proportion of mixed infection was high.Conclusions The occurrence of VAP could be lessened by rational use of antibiotics,reduction of duration of mechanical ventilation,diminution of contra-flow and reduction of re-intubation.Gram-negative bacteria are the most common pathogens,and the incidence of mixed infection is high,which should be prevented and treated positively.Antibiotics should be rationally used according to local etiology and chemical proof.