肿瘤患者呼吸机相关性肺炎的危险因素及病原学特点  

Risk factors of ventilator-associated pneumonia in tumor patients and pathogenic characteristics

作　　者：赵擎宇[1,2] 陈冠璇[1] 顾葆春[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心ICU,广东广州510060 [2]华南肿瘤学国家重点实验室中山大学感染管理科,广东广州510060

出　　处：《中华医院感染学杂志》2011年第17期3593-3596,共4页Chinese Journal of Nosocomiology

基　　金：卫生部专项基金(卫规财[2009]172号)

摘　　要：目的分析肿瘤专科医院重症监护病房中呼吸机相关性肺炎(VAP)相关危险因素及病原学特点。方法对癌症中心ICU 2006年1月-2009年12月收治并行有创呼吸机辅助机械通气患者的临床资料进行分析,根据VAP定义将其筛选为VAP组和未发生VAP者为对照组,分析发生VAP的危险因素。结果 153例肿瘤患者在ICU行有创呼吸机辅助通气中74例发生VAP,VAP发生率为48.4%;氧和指数(OI)<200、急性生理性与慢性健康状况评分Ⅱ(APACHEⅡ)>20、年龄≥60岁以及美国临床实验室标准化研究所(CLIS)评分>6是发生VAP的主要危险因素;VAP患者共培养出病原菌258株,革兰阴性菌占62.4%,主要为铜绿假单胞菌、嗜麦芽寡养单胞菌、鲍氏不动杆菌;革兰阳性菌占20.2%,主要为溶血葡萄球菌、表皮葡萄球菌;真菌占17.4%,以白色假丝酵母菌为主。结论该肿瘤专科医院,ICU机械通气患者VAP的发生率较高,病情危重、氧合差、APACHEⅡ、CLIS评分高是重要危险因素,VAP的病原菌分布和抗菌谱有别于综合医院ICU。OBJECTIVE To investigate the risk factors and pathogens in our Intensive Care Unit（ICU） complicated with ventilation-associated pneumonia.METHODS The clinical and pathogens data of 153 inpatients underwent mechanical ventilation in our ICU were analyzed retrospectively.RESULTS VAP occurred in 74 patients;The oxygenation index（OI）〈 200 after mechanical ventilation for 48 hours,APACHEⅡSore〉 20,CLIS Sore〉 6 were factors significantly different between the VAP patients and their control（P〈0.05）.Among the 74 VAP patients,258 strains were isolated,62.4% of which were gram-negative bacteria mainly composed of Stenotrophomonas maltophilia,Pseudomonas aerations and Acinetobacter calcoaceticusand.Gram-positive bacilli,mainly Staphylococcus haemolyticus and Staphylococcus epidermidis,and fungi,mainly Candida albicans were found at 20.2% and 17.4% respectively of the detected pathogens.CONCLUSION VAP occurs more often in the ICU of cancer patients.Risk factors includ agedness,severity of disease,low oxygenation high APACHEⅡscore and high CLIS score.The distribution of pathogens causing VAP and pathogenic spectrum are different from ICU in general hospital.

关 键 词：肿瘤 呼吸机相关性肺炎 机械通气 

分 类 号：R181.32[医药卫生—流行病学]