机械通气患者下呼吸道感染与气路管道的细菌污染关系的研究  

Relationship between bacterial pollution of breathing circuit and lower respiratory tract infection of patients with mechanical ventilation

作　　者：王海宾[1] 阎锡新[1] 薛士敏[1] 

机构地区：[1]河北医科大学第二医院呼吸内科

出　　处：《临床荟萃》2005年第4期196-199,共4页Clinical Focus

摘　　要：目的　研究呼吸重症监护病房 (RICU)内机械通气患者呼吸机气路管道、口咽部及下呼吸道不同时间段、不同部位的致病菌的细菌学情况 ,以评价气路管道的污染与下呼吸道感染的关系 ,探讨气路管道更换或消毒最佳时间。方法　对RICU内 38例机械通气患者于 4 8小时 ,7天 ,14天送检的 4 37份标本 ,进行细菌培养、药敏及定量分析。结果　送检 4 37份标本 ,培养结果中 2 6 2份标本分离出菌株 4 14株 ,以革兰阴性杆菌为主 ,占 87.2 0 % ;革兰阴性杆菌以铜绿假单胞菌、鲍曼不动杆菌和大肠埃希菌为主 ;气路管道污染率与时间同步增长 ,并与下呼吸道、咽部、气囊上滞留物感染菌具有一致性。结论　RICU内机械通气患者应在 4 8小时至 7天 ,依据气路管道的污染情况及时更换循环管路 ,下呼吸道感染与气路管道污染的细菌具有相关性。Objective By studying the bacteriological data of the patients with mechanical ventilation in respiratory intensive care unit(RICU) at different time and different parts such as breathing circuit,oropharynx and lower respiratory tract,to identify the relationship between the pollution of breathing circuit and lower respiratory tract infection for the best time to change breathing circuit. Methods Four hundred and thirty-seven samples were collected from 38 patients admitted in RICU at 48 hours,7 days and 14 days after mechanical ventilation for bacterial culture,drug-sensitive test and quantitative analysis. Then the bacteriological data were analyzed statistically. Results Four hundred and fourteen strains of pathogens were separated from 262 of 437 samples.The most common pathogens were gram-negative bacilli,accounting for 87.20%, especially pseudomonas aeruginosa, acinetobacter baumannii and escherichia coli. The incidence of breathing circuit pollution increased correspondingly with time and its pathogens were similar with those of lower respiratory tract, oropharynx and subglottic secretion. Conclusion The breathing circuit of the patients with mechanical ventilation in RICU should be changed timely according to the degree of pollution from 48 hours to 7 days. The pathogens of lower respiratory tract infection have relativity with those of breathing circuit pollution.

关 键 词：呼吸 人工 细菌 呼吸道感染 交叉感染 

分 类 号：R605.973[医药卫生—急诊医学]