摘要
目的:探究监护室使用呼吸机发生相关性肺炎(VAP)的危险因素,为临床工作提供有效帮助。方法:收集我院2015-01-01-2016-12-31监护室行机械通气患者150例,按照是否发生呼吸机相关性肺炎分为对照组与观察组。对照组108例,住院期间未发生呼吸机相关性肺炎;观察组42例,住院期间已发生呼吸机相关性肺炎。对这两组患者的临床资料进行对比分析,分析病原菌特点以及发生呼吸机相关性肺炎的危险因素。结果:从42例已发生VAP的患者的痰液中分离出病原菌83株,主要包括:金黄色葡萄球菌(27.71%)、表皮葡萄球菌(14.46%)、铜绿假单胞菌(18.07%)、鲍曼不动杆菌(19.28%)。表皮葡萄球菌对青霉素、磺胺甲噁唑、罗红霉素等具有较强的耐药性,而对替考拉林、万古霉素、呋喃妥因等具有较强的敏感性。金黄色葡萄球菌对青霉素、阿莫西林克拉维酸钾、阿奇霉素、罗红霉素等具有较强耐药性,对万古霉素、替考拉宁、利奈唑胺等具有较强敏感性;铜绿假单胞菌和鲍曼不动杆菌对头孢唑林、阿莫西林、复方新诺明等具有较强耐药性,而对头孢哌酮舒巴坦、美罗培南、阿米卡星等具有较强敏感性。单因素分析显示VAP主要与年龄、机械通气时间、是否出现昏迷、是否开放式吸痰、是否应用抑酸剂、是否进行鼻胃管喂养、是否应用广谱抗生素、脑血管疾病有关(P<0.05);而与性别、高血压、糖尿病、冠心病无关。独立因素Logistic分析显示较长机械通气时间、出现昏迷、开放式吸痰、应用抑酸剂、未应用广谱抗生素、患有脑血管疾病等因素为ICU患者院内感染的独立危险因素(P<0.05)。结论:研究监护室病房内VAP发生的危险因素,提出相应的预防措施,可以为患者营造良好的治疗环境,具有十分重要的现实意义。
Objective：To explore the risk factors of ventilator-associated pneumonia（VAP）in ICU,and to provide corresponding help for clinical work.Method：One hundred and fifty patients with ventilator-associated pneumonia who were admitted to ICU from January 1,2015 to December 31,2016 were divided into control group and observation group according to whether or not ventilator-associated pneumonia occurred.Group of 108 cases,during the hospital did not occur ventilator-associated pneumonia;observation group of 42 cases,during the hospital has occurred ventilator-associated pneumonia.The clinical data of these two groups were compared and analyzed,and the proportion of the pathogens was analyzed and analyzed.Result：Eighty-three strains of pathogens were isolated from 42 cases of VAP patients,including the following kinds：Pseudomonas aeruginosa（18.07%）,Staphylococcus aureus（27.71%）,Acinetobacter baumannii（19.28%）,Staphylococcus epidermidis（14.46%）.Staphylococcus epidermidis has strong resistance to penicillin,sulfamethoxazole and roxithromycin,and has strong sensitivity to teicoplanin,vancomycin and nitrofurantoin.Staphylococcus aureus has strong resistance to penicillin,amoxicillin clavulanate,azithromycin,roxithromycin and so on.It has strong sensitivity to vancomycin,teicoplanin and linezolidamine.Pseudomonas and Acinetobacter baumannii have strong resistance to cefazolin,amoxicillin and cotrimoxazole,and the effects of cefoperazone sulbactam,meropenem and amikacin Strong sensitivity.Univariate analysis found that VAP mainly with age,mechanical ventilation time,whether there is coma,whether open suction,whether the application of acid suppressor,whether nasogastric feeding,whether the application of broad-spectrum antibiotics,cerebrovascular disease（P0.05）,but not with gender,hypertension,diabetes mellitus and coronary heart disease.Independent factors logistic analysis,the discovery of mechanical ventilation time,whether there is coma,whether open suction,whether the application of acid sup
出处
《临床急诊杂志》
CAS
2017年第11期838-841,846,共5页
Journal of Clinical Emergency
基金
基金项目:超长心肺复苏的临床研究(No:2012YL03)
