摘要
目的分析急性加重期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者应用机械通气治疗导致呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)发生的因素。方法收集2017年1月1日-2017年12月31日期间因急性加重期COPD疾病于杭州市第一人民医院进行机械通气治疗的494例患者资料。根据是否发生VAP感染将患者分为VAP感染组与非VAP感染组。分析两组住院时间及病死率的差异;对两组患者性别、年龄、上机时间、持续时间、气管插管、合并疾病、吸烟史及一年内机械通气史等多项临床病案资料进行综合分析,明确患者机械通气治疗导致VAP感染发生的影响因素;分析急性加重期COPD患者VAP感染病原菌分布情况。结果 494例患者经机械通气治疗后共23例发生VAP感染,发生率为4.66%;VAP组住院时间及病死率均高于非VAP组(P<0.05);34株病原菌以革兰阴性菌中的铜绿假单胞菌为主,占41.18%,铜绿假单胞菌对头孢噻吩、头孢西丁及头孢拉定耐药性较高,对诺氟沙星及亚胺培南耐药性极低;上机时间<5 d、持续时间≥3 d、气管插管、合并糖尿病、有吸烟史、留置胃管为导致患者VAP感染发生的主要影响因素(P<0.05);机械通气上机时间与VAP发生率呈负相关(r=-0.832,P<0.05);机械通气持续时间与VAP发生率呈正相关(r=0.871,P<0.05)。结论 VAP感染病原菌主要以铜绿假单胞菌为主,感染的发生受上机时间、持续时间、气管插管、合并糖尿病、吸烟史、留置胃管等因素影响。
OBJECTIVE To analyze the factors related to ventilator-associated pneumonia(VAP) infection in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD). METHODS The data of 494 patients undergoing mechanical ventilation in the First People’s Hospital of Hangzhou due to acute exacerbation of COPD from Jan. 1, 2017 to Dec. 31, 2017 were collected. The subjects were divided into VAP infection group and non-VAP infection group according to the occurrence of VAP infection. The differences in hospitalization time and fatality rate between the two groups were analyzed, and the clinical case data of the two groups such as gender, age, starting time of ventilation, duration of ventilation, endotracheal intubation, complicated disease, smoking history and the history of mechanical ventilation within one year were analyzed comprehensively to determine the influencing factors of VAP infection in the patients with mechanical ventilation. The distribution and proportion of pathogens of VAP infection in patients with acute exacerbation of COPD were analyzed. RESULTS A total of 23 cases of VAP infection occurred in the 494 patients after mechanical ventilation, and the incidence of VAP infection was 4.66%. The hospitalization time and mortality in the VAP group were significantly higher than those in non-VAP group(P<0.05). Among the 34 strains of pathogens, the Gram-negative bacteria P aeruginosa was the major pathogen, accounting for 41.18%. P aeruginosa had relatively high resistance to cefalotin, cefoxitin and cephradine, and very low resistance to norfloxacin and imipenem. The time of starting using ventilator <5 d, duration of ventilation ≥3 d, endotracheal intubation, diabetes, smoking history, indwelling gastric tube were the main influencing factors of VAP infection in patients with acute exacerbation of COPD(P<0.05). There was a significant negative correlation between the starting time of mechanical ventilation and the incidence of VAP(r=-0.832, P<0.05), and the duration of mechanical ventilat
作者
陈竹芳
王俊
沈小玲
桑贤印
汪利芬
CHEN Zhu-fang;WANG Jun;SHEN Xiao-ling;SANG Xian-yin;WANG Li-fen(First People's Hospital of Hangzhou,Zhejiang 310000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第16期2426-2430,共5页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(30971317)
关键词
急性加重期COPD
机械通气
通气时间
呼吸机相关性肺炎
Acute exacerbation of COPD
Mechanical ventilation
Ventilation time
Ventilator-associated pneumonia
