新生儿呼吸机相关性肺炎危险因素及病原菌状况分析  

Neonatal ventilator-associated pneumonia:risk factors and pathogens profile

作　　者：邹友富[1] 邓春[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿科,重庆400014

出　　处：《重庆医科大学学报》2010年第10期1550-1555,共6页Journal of Chongqing Medical University

摘　　要：目的:探讨新生儿呼吸机相关性肺炎(Ventilator-associated pneumonia,VAP)的危险因素、病原菌的分布和药敏情况。方法:收集2006年5月至2009年5月重庆医科大学附属儿童医院新生儿科机械通气(Mechanical ventilation,MV)大于48 h患儿的临床资料进行回顾性调查分析。结果:VAP的发病率为46.30%。单因素分析结果显示MV时间、出生体重、胎龄、气管插管次数有统计学意义。多因素Logistic回归分析显示MV时间是VAP的危险因素。94例VAP患儿共分离出病原菌116株,其中革兰阴性杆菌75株(占64.65%),革兰阳性球菌27株(占23.28),真菌14株。病原菌以肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌最常见。药敏显示病原菌对临床常用抗生素均有多重耐药现象,仅对部分抗生素敏感。结论:VAP有较高发病率,新生儿VAP的发生受MV时间、出生体重、胎龄、气管插管次数等多种因素影响,应采用综合预防措施防止VAP的发生。VAP的病原菌以革兰氏阴性菌为主,有多重耐药现象,因此根据药敏情况合理使用抗生素对治疗VAP很重要。Objective：To investigate the risk factors,pathogen distribution,and drug sensitivity of neonatal ventilator-associated pneumonia （VAP）. Methods：The clinical data of all mechanical ventilated （≥48 h）patients who were admitted to the neonatology of Children＇s Hospital of Chongqing Medical University from may 2006 to may 2009 were collected. The incidence of VAP,the risk factors and pathogenic bacteria culture results were retrospectively analyzed. Results：The morbidity of VAP was 46.30%. Univariate analysis showed that the time for mechanical ventilation,birth weight,gestational age,and the number of tracheal intubation were all related to the occurrence of VAP. Multivariate Logistic regression analysis showed that the time for mechanical ventilation was an independent risk factor for VAP. 116 strains of bacterium were found from the total 94 patients with VAP ,of which 75 strains were Gram-negative bacilli;27 strains were gram-positive cocci;14 strains were fungi. The most common pathogens were Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa. The antibiotics-sensitivity showed multidrug resistance to most commonly used antibiotics,but sensitivity to only a few antibiotics. Conclusion：The morbidity of VAP was very high.The incidence of VAP was related to the time for mechanical ventilation ,birth weight,gestational age,the number of endotracheal intubation and other factors. Comprehensive treatment should be used to prevent the incidence of VAP. The main VAP pathogenic bacterium was gram negative bacilli. The multi-drug resistant pathogenic bacteria were common. So the rational use of antibiotics according to drug sensitivity is important in treating VAP.

关 键 词：呼吸机相关性肺炎 危险因素 病原菌 耐药性 

分 类 号：R722.13[医药卫生—儿科]