摘要
目的:通过对外科重症监护室(ICU)内近两年医院获得性肺炎(HAP)的病原学特征进行分析,针对主要的感染途径制订HAP预防的主要措施,旨在进一步降低ICU内HAP的发生率。方法:将2004年1月至2005年12月间收住该科ICU、住院时间>48 h、并具有以下特征之一的患者作为重点观察对象:①建立人工气道患者。②急性生理学与慢性健康评价(APACHEⅡ)评分≥12分。③伴有急性肺损伤(ALI)、急性呼吸窘迫综合征(ARDS)的患者。④慢性阻塞性肺病(COPD)、慢性支气管炎等其他肺部疾患者。⑤免疫功能低下,人类免疫缺陷病毒(H IV)辅助细胞计数(CD4)/H IV抑制细胞计数(CD8)<0.9。气道护理工作由专职气道护理人员进行,2次/周进行痰液采样及细菌鉴定,结合临床表现及X线征象登记HAP患者的临床资料。结果:发生HAP者79例,分离出致病菌263株,革兰阴性菌占59.31%,革兰阳性菌占28.90%,真菌占11.79%。前三位致病菌依次为铜绿假单胞菌(51株)、鲍曼不动杆菌(46株)和金黄色葡萄球菌(41株)。耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的53.66%。结论:我院外科患者术后HAP发生与人工气道和机械通气密切相关,致病菌以革兰阴性菌为主。根据HAP致病菌的特点,针对感染的几个主要环节进行重点的预防管理,并采取专人护理人工气道和呼吸机辅助呼吸患者的方法,可望有效降低HAP的发生率,并提高治愈率。
Objecttive ： The etiological characters of hospital acquired pneumonia （HAP） in the last two years were compared and the prevention methods of main infection mutes were made to decrease the morbidity of HAP in surgical ICU. Methods ：The patients were enrolled from Jan. 2004 to Dec. 2005 ： （1） artificial airway. （2）APACHE Ⅱ 〉 12. （3）acute lung injury （ALI）,acute respiratory distress syndrome （ARDS）. （4）chronic bronchitis, chronic obstructive pulmonary diseases （ COPD ）. （5）hypoimmunity （ CD4/ CD8 〈 0.9）. The airway care was managed by the professional airway care nursers, the sputum was sampled and identified of bacteria and the clinical date of HAP patients was record. Results ： The pathogenic bacteria were 263 strains,gram negative was at 59.61%, gram positive was at 28.9% and fungus was at 11.79 % from the samples of 79 HAP patients . The above three bacteria were pseuduomonas- aeruginosa （ 51 ）, baumanii （46）, staphylococcus aureus （41 ）. MRSA was at 53.66 percent of staphylococcus aureus. Conclusion：The HAP is related to the artificial airway and mechanical ventilation in surgical postoperative patients and the first pathogenic bacteria is pseuduomonas-aeruginosa. According to the analysis of pathogenic bacteria, the prevention of several key steps and professional airway care could improve the outcome of HAP patients.
出处
《医学研究生学报》
CAS
2007年第1期43-45,48,共4页
Journal of Medical Postgraduates
基金
军队"十五"医药卫生科研基金重点资助项目(批准号:01Z011)
南京军区南京总医院科研基金资助项目(批准号:2002057)
关键词
医院获得性肺炎
预防
Hospital acquired pneumonia
Precaution
