不同医疗机构医院获得性肺炎转归及病原构成的回顾性分析  

Conversion of acquired pneumonia and constitution of pathogens in different medical institutions:a retrospective analysis

作　　者：朱佑明[1,2] 王利亚 黄永红 罗永艾[2] 

机构地区：[1]重庆医科大学附属第一医院呼吸内科,重庆400016 [2]重庆市第一人民医院ICU,重庆400022 [3]重庆市第一社会福利院福康医院内科,重庆400054 [4]重庆市第六人民医院内科,重庆400060

出　　处：《第三军医大学学报》2011年第18期1986-1990,共5页Journal of Third Military Medical University

摘　　要：目的了解重庆地区医院获得性肺炎(hospital acquired pneumonia,HAP)治疗转归、病原学分布及其耐药性特点,为本地区治疗HAP提供资料和依据。方法选取重庆市不同等级4家医疗机构在2009年1月至2010年12月符合HAP诊断标准的病例512例,对患者的性别、年龄、治疗转归、基础疾病、病原学及其耐药谱进行回顾性对照研究。结果 4家医疗机构的HAP患者性别不存在差异,平均年龄以重庆市第一福利院(78.6岁)最高,与其他3组存在显著性差异(P<0.05)。HAP总死亡率为23.4%。与本次住院直接相关的基础疾病分析显示脑卒中及其后遗症是导致HAP最常见的原因(24.4%),其次是呼吸衰竭(包括急性和慢性)(17.2%),其他依次为心血管病(8.3%)、肿瘤(7.7%)、手术后(7.1%)、慢性阻塞性肺疾病(6.9%)、尘肺(5.9%)、糖尿病(4.4%)、老年痴呆(3.8%)、营养不良(2.4%)。HAP病原菌以G-菌为主,占73.2%,以铜绿假单胞菌(27.2%)最常见;G+菌占22.9%,以金黄色葡萄球菌(13.0%)最常见;真菌占3.9%,均为混合感染。在福利院发生的HAP病原菌以肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌和表皮葡萄球菌为主。结论重庆地区HAP死亡率较高,脑卒中及其后遗症是导致HAP最常见的原因。在福利院与在其他医疗单位发生的HAP病原谱不同。HAP病原菌以铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌为主,耐药情况严重。Objective To investigate the conversion of hospital acquired pneumonia（HAP）,distribution of its etiology and characteristics of its drug-resistance in order to provide evidence for its treatment.Methods Five hundred and twelve HAP patients fulfilling the diagnostic criteria for HAP admitted to 4 different medical institutions in Chongqing from January 2009 to December 2010 were enrolled in this study.Their gender,age,conversion after treatment,basic disease,distribution of etiology,and drug-resistant spectra were retrospectively studied.Results No significant difference was observed in gender of HAP patients admitted to the 4 different medical institutions in Chongqing.The average age of HAP patients in Chongqing First Social Welfare Institution was 78.6±7.3,which was higher than that of those in the other 3 medical institutions（P0.05）.The total mortality of HAP patients was 23.4% in Chongqing.The analysis of basic diseases directly related with hospital stay showed that cerebral stroke and its sequel were the common reasons for HAP（24.4%）,followed by acute and chronic respiratory failure（17.2%）,cardiovascular disease（8.3%）,tumor（7.7%）,post-operation（7.1%）,chronic obstructive disease of lung（6.9%）,silicosis（5.9%）,diabetes mellitus（4.4%）,senile dementia（3.8%）,and dystrophy（2.4%）.The main pathogens of HAP were Gram-negative bacteria（73.2%） especially Pseudomonas aeruginosa（27.2%）,followed by Gram-positive bacteria（22.9%） especially Staphylococcus aureus（13.0%）,and fungi（3.9%）.The etiological pathogens of HAP found in Fukang Hospital of Chongqing First Social Welfare Institution were Streptococcus pneumoniae,Hemophilus influenza,Staphylococcus aureus,Escherichia coli and Staphylococcus epidermidis.Conclusion The mortality of HAP patients is rather high in Chongqing.Cerebral stroke and its sequel are the common reasons for HAP.The pathogenic spectra of HAP in Chongqing Social Welfare Institution are different from those in the other 3 medical instit

关 键 词：医院获得性肺炎 转归 临床分布 细菌耐药性 

分 类 号：R563.101[医药卫生—呼吸系统] R181.34[医药卫生—内科学]