摘要
目的 探讨老年机械通气患者发生多重耐药菌（MDRO）混合感染的危险因素.方法 回顾性分析我院ICU收治的72例老年机械通气患者的临床资料,分为非VAP组、VAP组、非MDRO组、单一MDRO组、混合MDRO组,比较患者入ICU一般情况、基础疾病既往史、机械通气情况、辅助治疗情况、抗生素使用情况及感染菌群.结果 患慢性呼吸系统疾病及患多种慢性基础疾病者,MDRO感染率增加;通气时间长,气管切开会增加MDRO混合感染的风险;使用全身激素雾化也是加剧MDRO混合感染的危险因素,尽早开始胃肠内营养可以减少MDRO混合感染的发生;基础治疗时滥用抗生素增加患者MDRO混合感染率;经验治疗＂降阶梯方案＂比＂升阶梯方案＂更易控制MDRO混合感染.结论 老年机械通气患者发生多重耐药菌（MDRO）混合感染的危险因素有：慢性基础性疾病的种类及数量、机械通气时间及方式、辅助治疗方案和抗生素使用情况,ICU在治疗老年机械通气患者时应从多方面着手控制MDRO混合感染.
Objective To discuss the risk factors of MDRO mixed infection in elderly patients with mechanical ventilation. Methods Analyze retrospectively the clinical data of 72 patients with mechanical ventilation in the ICU by dividing them into non-VAP group, VAP group, non-MDRO group, single MDRO group and mixed MDRO group. Their general condition, the history of underlying disease, the condition of mechanical ventilation and adjuvant therapy, the use of antibiotics and infection bacteria were compared. Results MDRO mixed infection rate increased when patients suffer chronic respiratory disease or more chronic underlying diseases. Ventilation for a long time and tracheotomy would increase the risk of MDRO mixed infection. Use of systemic hormone spray would also be the risk factors of MDRO mixed infection. Early enteral nutrition might reduce the incidence of MDRO mixed infection. Abusing of antibiotics would increase the rate of MDRO mixed infection. Empirical treatment, ＂de-escalation plan＂ is considered being easier than ＂up the ladder program＂ to control MDRO mixed infection. Conclusion The risk factors of MDRO mixed infection in elderly patients with mechanical ventilation include the type and quantity of underlying disease, the time and method of mechanical ventilation, adjuvant therapy and the use of antibiotics. ICU should take measures from different areas to control MDRO mixed infection in elderly patients with mechanical ventilation.
出处
《中国急救复苏与灾害医学杂志》
2011年第12期1059-1062,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
