呼吸机相关性气管支气管炎对机械通气患者预后的影响  

Effect of ventilator - associated tracheobronchitis on prognosis of mechanical ventilation patients

作　　者：王建中[1] 李坚[2] 魏建军[1] 徐君美[1] 

机构地区：[1]扬中市人民医院呼吸科,江苏扬中21200 [2]江苏大学附属医院呼吸科

出　　处：《中国急救医学》2012年第8期682-685,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的评价呼吸机相关性气管支气管炎（ventilator—associatedtracheobronchitis，VAT）对机械通气患者预后的影响。方法选择符合VAT诊断标准（即机械通气48h后出现发热、脓性痰、痰细菌培养阳性及影像学无新出现的浸润影或实变影）56例患者作为研究对象，根据是否发展为呼吸机相关性肺炎（VAP）分成VAT＋VAP组（n=22）和VAT组（n=34）。分析两组患者机械通气后抗菌药物使用情况、痰细菌培养结果、机械通气时间、住ICU时问、气管切开率及病死率。结果56例VAT患者纳入本研究。VAT＋VAP组的抗菌药物不恰当使用率明显高于VAT组（P=0．001），多重耐药菌分离率及2种或以上细菌混合感染率高于VAT组（P=0．001和P=0．007）。此外，VAT＋VAP组的机械通气时间和住ICU时间长于VAT组（P均为0．001），气管切开率与病死率亦高于VAT组（P=0．005和P=0．008）。结论机械通气患者发生VAT后，若不能早期诊断并给予及时的靶向抗菌药物治疗易于发展为VAP，VAT和VAP的连续发生可延长患者机械通气及住ICU时间，增加气管切开率与病死率，影响预后。Objective To evaluate the effect of ventilator - associated tracheobronchitis （VAT） on outcome in patients receiving mechanical ventilation. Methods This was a retrospective observational matched study. The eligibility criteria of patients for the study were the presence of a first episode of VAT diagnosed more than 48 hours ＇after mechanical ventilation. Patients were divided as VAT ＋ ventilator associated pneumonia （VAP） group and VAT group according to the development of subsequent VAP or not. The data analyzed included the use of antibiotic, mierobiologic examination, duration of mechanical ventilation and intensive care unit （ICU） stay, tracheotomy and mortality rates. Results Fifty six patients were included in the study. Number of patients who received inadequate antibiotic treatment was significantly more in the VAT ＋ VAP group than in the VAT group（ P = 0. 001 ）. The rates of isolated multidrug - resistant bacteria and polymicrobial were higher in VAT ＋ VAP group than in the VAT group（P =0. 001 and P =0. 007）. Compared with the VAT group, the VAT ＋ VAP group had longer duration of mechanical ventilation and ICU stay（ P = 0.001 all） , more tracheotomy and higher mortality rates （ P = 0. 005 and P = 0. 008 ）. Conclusion The patients with VAT were apt to develop subsequent VAP if VAT can be not diagnosed early and treated immediately using targeted antibiotic. In patients receiving mechanical ventilation, the development of VAT and subsequent VAP was associated with longer duration of mechanical ventilation and ICU stay, and more tracheotomy and higher mortality rates.

关 键 词：呼吸机相关性气管支气管炎(VAT) 呼吸机相关性肺炎(VAP) 机械通气 抗菌药物 预后 

分 类 号：R563.1[医药卫生—呼吸系统]