早发性与晚发性呼吸机相关性肺炎病原学分析  

Early-onset and Late-onset Ventilator-associated Pneumonia:Their Etiology

作　　者：谭薇[1] 郭桂芳[1] 王乐强[1] 刘婷[1] 于振刚[1] 

机构地区：[1]潍坊医学院附属潍坊市人民医院,山东潍坊261041

出　　处：《中华医院感染学杂志》2007年第5期524-526,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨早发性与晚发性呼吸机相关性肺炎(VAP)的病原菌分布,为临床合理使用抗菌药物,预防VAP的发生及治疗提供理论依据。方法选取74例机械通气VAP患者,采用病原学、显微镜鉴定、细菌培养等方法,对早发性与晚发性VAP的病原菌构成进行对比分析。结果在74例VAP患者中共检出致病菌121株,早发性VAP 29例,检出致病菌36株;晚发性VAP 45例,检出致病菌85株;晚发性VAP中革兰阴性杆菌比例明显高于早发性VAP中革兰阴性杆菌比例(χ2=10.551,P<0.01);在29例早发性VAP者培养的36株致病菌中,单纯培养占发病例次66.67%,混合培养占33.33%;在45例次晚发性VAP者培养的85株致病菌中,单纯培养占发病例次17.65%,混合培养占82.35%,二者相比较,晚发性VAP的混合培养比例显著高于早发性VAP(2χ=27.821,P<0.01)。结论晚发性VAP致病原菌的分布以革兰阴性细菌为主;对VAP的混合培养比例比较,晚发性显著高于早发性。OBJECTIVE To probe the pathogen＇s distribution of ventilator-associated pneumonia（VAP）, in order to offer the evidence of clinical therapy, prevent the onset of VAP and apply the antibiotics reasonably. METHODS We applied the methods of etiology, microscopic identification, bacteria culturing etc on 74 mechanical ventilation patients, and analyzed the etiology of early-onset and latonset VAP in contrast. RESULTS Totally 121 pathogens were cultivated altogether in all 74 VAP patients. In the 36 pathogens which were cultivated from 29 early-onset VAP patients, there were 66. 67% of simple culture （24 patients, 24 strains） and 33. 33% of co-culture （5 patients, 12 strains）, and in the 85 pathogens which were cultivated from 45 late-onset VAP patients there were 17.64% of simple culture （15 patients, 15 strains） and 82.35% of co-culture （30 patients, 70 strains）. The proportion of co-culture in the late-onset VAP patients was prominantly higher than that in the early-onset ones （X^2=27.821, P〈0. 01）. The proportion of Gram-negative bacteria （GNB） in the late-onset VAP was prominantly higher than that in the early-onset VAP（X^2 = 10. 551, P%0.01）. CONCLUSIONS The formation of VAP＇s pathogen is GNB mainly. The ratio of co-culture in the late-onset VAP is prominantly higher than that of the early-onset VAP.

关 键 词：早发性 晚发性 呼吸机相关肺炎 病原学 

分 类 号：R563.1[医药卫生—呼吸系统]