新生儿呼吸机相关性肺炎病原菌特点及诊断探讨  

Diagnosis of neonatal ventilator associated pneumonia and characteristics of its pathogens

作　　者：朱远鹏[1] 周平[1] 邓华艳[1] 韩玉昆[2] 

机构地区：[1]广东省深圳市宝安区妇幼保健院新生儿科,518133 [2]中国医科大学第二临床医院新生儿科

出　　处：《中国新生儿科杂志》2007年第5期257-259,共3页Chinese Journal of Neonatology

摘　　要：目的了解新生儿呼吸机相关性肺炎(VAP)的临床特点。方法回顾性分析我院新生儿重症监护病房2004年1月至2006年10月机械通气≥48h的102例患儿临床资料。结果并发VAP53例,占51.9%,诊断时间平均在机械通气后90.3(±22.5)h,临床表现以胸片浸润阴影(100%)、呼吸道内出现脓性分泌物(88.7%)、肺部湿罗音(77.4%)及PCO2>45mmHg(64.2%)为主。发热28例(52.8%),白细胞增多12例(22.6%),51例痰培养阳性(96.2%),其中革兰阳性球菌占53.8%,革兰阴性杆菌占46.2%。肺炎克雷伯菌、溶血葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌、大肠埃希菌、阴沟肠杆菌是6种主要致病菌,耐药率高。放弃治疗及死亡12例,占22.6%。结论VAP病原复杂、易变,应严格掌握抗生素的适应症,避免过多使用抗生素,防止耐药菌株的出现。Objective To study the clinical characteristics of neonatal ventilator associated pneumonia （VAP）. Methods Clinical data related with VAP in 102 ventilated neonates were analyzed. Results Fifty-three babies developed VAP （51.9%）. Ventilation duration when VAP onset was （93.3 ± 22. 5） h. The main clinical manifestations were infiltrate on chest X-ray film （ 100% ） , purulent secretion in respiratory tract （88.7%）, pulmonary rales （77.4% ）, PCO2〉45 mm Hg （64.2% ）, fever （52.8% ）, elevated WBC （22. 1% ） and positive bacterial culture （96.2%）. Among the positive bacterial cultures, 53.8% was Gram positive coccus, 46.2% was Gram negative bacillus. The leading pathogens were Kleb- siella pneumoniae, Staphylococcus hemolyticus, Staphylococcus epidermidis, Staphylococcus aureus, Coli Escherichia, and Bacillus subtilis. Twelve babies （ 22.6% ） died or gave up treatment. Conclu- sions The pathogens causing VAP are complex and variable. Indications and guidelines for antibiotic therapy should be strictly followed to avoid over usage of antibiotics and prevent drugs resistance. Hyper- capnia is a predictor of VAP.

关 键 词：通气机 机械 肺炎 诊断 

分 类 号：R722.1[医药卫生—儿科]