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目的:了解呼吸内科重症监护病房(RICU)机械通气患者并发呼吸机相关性肺炎(VAP)的临床相关因素和细菌学特点。方法:回顾性分析呼吸机相关性肺炎患者38例发病时间和病原学特点。结果:RICU重症患者机械通气≥48 h 87例,并发VAP 38例,发病率为43.7%。重症患者并发VAP时病死率39.5%。VAP机械通气平均发生在(5.1±2.2)d,与机械通气时间、意识障碍相关;VAP致病菌以革兰氏阴性杆菌感染为主,占81.1%,药敏试验显示对多种常用抗生素耐药。结论:RICU呼吸机相关性肺炎发生率、病死率高,革兰氏阴性杆菌仍为主要病原菌,尽可能缩短呼吸机使用时间、合理使用抗生素、严格无菌操作,有利于呼吸机相关性肺炎控制。
Objective: To investigate the clinical and bacteriological characteristics of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in Respiratory Medical Intensive Care Unit (RICU). Methods: A retrospective analysis of 38 patients with ventilator-associated pneumonia onset time and etiological characteristics. Results: 87 cases of mechanical ventilation of severe ICU patients with severe chronic obstructive pulmonary disease (NICU) occurred in 48 h and 38 patients were complicated with VAP. The incidence rate was 43.7%. Severe patients complicated with VAP mortality was 39.5%. VAP mechanical ventilation occurred on average (5.1 ± 2.2) d, which was related to mechanical ventilation time and disturbance of consciousness. VAP pathogens were mainly Gram-negative bacilli, accounting for 81.1%. Antibiotic susceptibility test showed that resistance to various commonly used antibiotics medicine. Conclusions: The incidence and mortality of ventilator-associated pneumonia in RICU are high, Gram-negative bacilli are still the main pathogenic bacteria, and the time of ventilator use is shortened as far as possible. The rational use of antibiotics and strict aseptic operation are beneficial to the control of ventilator-associated pneumonia .