封闭式气道管理对机械通气患者下呼吸道病原菌分布及耐药性的影响  

Effects of closed airway management on distribution and drug susceptibility of pathogenic bacteria in lower respiratory tract of mechanical ventilated patients

作　　者：刘宁[1] 刘建英 顾勤[1] 

机构地区：[1]南京大学医学院附属鼓楼医院ICU,江苏南京210008 [2]南京军区机关医院外科

出　　处：《中国呼吸与危重监护杂志》2008年第6期427-430,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的比较机械通气患者采用封闭式气道管理系统与开放式吸引系统对下呼吸道病原菌及耐药性的影响。方法选择南京大学医学院附属鼓楼医院ICU 2006年5月~2006年12月的59例机械通气时间大于48 h的危重症患者,随机分为两组,采用不同的气道管理方式。A组29例采用封闭式气道管理系统（包括封闭式吸痰管与人工鼻）,B组30例采用常规开放式吸引系统（包括开放式吸痰管与加热湿化罐）。对患者的下呼吸道分泌物进行细菌定量培养及抗生素敏感性测定。结果A组共获得下呼吸道分泌物菌株91株,以单一病原菌为主（41.4%）,其次为两种病原菌（34.5%）,两种以上病原菌者较少（24.1%）。B组获得分泌物菌株141株,以两种以上病原菌为主（53.33%）,其次为两种病原菌（30%）,单一病原菌较少（16.7%）。A、B两组患者的病原菌菌种分布依次为革兰阴性菌（分别为63.74%和75.89%）、革兰阳性菌（分别为20.88%和14.89%）与真菌（分别为15.4%和9.22%）。两组患者之间病原菌分布无显著差异（P〉0.05）,均以革兰阴性菌为主,主要为鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌和肺炎克雷伯菌,两组的革兰阳性菌也以金黄色葡萄球菌为主。两组主要病原菌的药敏试验结果无显著差异（P〉0.05）。结论封闭式气道管理系统的应用可减少病原菌的混合感染或定植,对病原菌分布及耐药性无明显影响。Objective To compare the effect of closed airway management system and open suction system on distribution and drug susceptibility of pathogenic bacteria in lower respiratory tract of mechanical ventilated patients. Methods Fifty-nine cases in ICU who received mechanical ventilation for more than 48 h from May 2006 to Dec 2006 were randomly divided into two groups. Group A（29 patients） received closed-tracheal suction and Group B （30 patients ） received open-tracheal suction. Quantitative bacteriological culture and sensitivity of antibacterial drugs were conducted on lower respiratory tract secretion samples. Results In group A, a total of 91 strains were isolated, in which a single pathogen infection（41.4% ） was the most frequent, followed by mixed infection of two pathogens （ 34. 5% ） and three or more pathogens（24. 1% ）. In group B,a total of 141 strains were isolated,in which three or more pathogen infection（53.33% ） was the most frequent, followed by two pathogen infection （30%） and a single pathogen infection （ 16. 7% ）. Pathogen distribution between the two groups was not significantly different（ P 〉 0. 05 ）. Drug susceptibility test did not show significant difference in main pathogens between the two groups （ P 〉 0.05 ）. Conclusions Closed airway management system can reduce the infection or colonization of mixed pathogens, but can not change the distribution and drug susceptibility of pathogens.

关 键 词：封闭式气道管理 下呼吸道 病原菌 定植 耐药性 

分 类 号：R459.6[医药卫生—治疗学] R446.5[医药卫生—临床医学]