摘要
目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。
OBJECTIVE To explore the distribution of pathogens causing ventilator-associated pneumonia（VAP）in patients with chronic obstructive pulmonary disease（COPD）during mechanical ventilation and analyze the related risk factors so as to provide guidance for clinical treatment of VAP.METHODS A total of 128 patients with COPD who were treated with mechanical ventilation from Jan 2012 to Jan 2016 were recruited as the study objects,the incidence of VAP in the COPD patients was analyzed during the mechanical ventilation,the univariate analysis and multivariate logistic regression analysis were performed for the related factors for VAP,and the eligible sputum specimens were collected for culture of pathogens.RESULTS Of the 128 COPD patients,88 had VAP,with the in-cidence rate 68.75%.Totally 125 strains of pathogens were isolated from the sputum specimens of the 88 VAP patients,of which 103（82.4%）were gram-negative bacteria,3（2.4%）were gram-positive bacteria,and 19 （15.2%）were fungi.The independent risk factors for the VAP in the COPD patients after the mechanical ventila-tion included the endotracheal intubation,complication with diabetes mellitus,mechanical ventilation duration no less than 3 days,smoking history and gastric tube indwelling.The mortality rate of the VAP patients was 31.8%,remarkably higher 7.5% of the non-VAP patients.CONCLUSION The incidence rate of VAP is high in the COPD patients undergoing the mechanical ventilation,there are a variety of risk factors for the VAP,and it is necessary for the hospital to reasonably use antibiotics in response to the pathogens causing the infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第22期5076-5078,5097,共4页
Chinese Journal of Nosocomiology
基金
邢台市科技计划基金资助项目(2012ZC174)
关键词
慢性阻塞性肺疾病
呼吸机相关肺部感染
机械通气
Chronic obstructive pulmonary disease
Ventilator-associated pneumonia
Mechanical ventilation
