呼吸科重症监护病房医院获得性肺炎临床分析  

Hospital-associated pneumonia in a respiratory intensive care unit:clinical analysis

作　　者：卢鑫[1] 孙文逵[1] 徐瑾[1] 李渺苗[1] 苏欣[1] 赵蓓蕾[1] 孙辉明[1] 施毅[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)呼吸与危重症医学科,南京210002

出　　处：《中国感染与化疗杂志》2012年第5期357-360,共4页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨呼吸科重症监护病房(RICU)医院获得性肺炎(HAP)的发病情况、危险因素、病原菌分布、治疗结局。方法回顾分析2008年8月—2010年8月于南京军区南京总医院RICU住院期间发生HAP患者的临床资料。结果 RICU住院患者HAP发生率为17.3%,主要的危险因素包括高龄,长期住ICU,患有慢性阻塞性肺疾病、心脑血管疾病、糖尿病、恶性实体瘤等基础疾病,应用多种抗生素,留置鼻饲管、导尿管、气管插管、中心及外周静脉导管,应用质子泵抑制剂,并发多脏器功能衰竭等。病原菌主要为鲍曼不动杆菌、铜绿假单胞菌、金葡菌。总病死率为42.0%,抗感染治疗有效率54.0%。结论针对高危人群采取积极预防措施,治疗基础疾病、降低危险因素、改善病房环境,同时根据药敏试验结果采用多种抗生素联合应用是治疗成功的关键。Objective To investigate the incidence, risk factors, pathogens and outcomes of hospital-associated pneumonia （HAP） in a respiratory intensive care unit （RICU）. Methods The clinical data of HAP patients in a RICU were reviewed retro- spectively from August 2008 to August 2010. Results The incidence rate of HAP was 17.3% in the RICU. Risk factors for HAP included age, long ICU stay, underlying diseases such as chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus, malignant tumors, invasive procedures, placement of catheter, use of proton pump inhibitor and multiple or- gan dysfunction syndrome. The main pathogens of HAP were Acinetobacter baumannii, Pseudornonas aeruginosa and Staphy- lococcus aureus. The overall mortality was 42%. About 54% of the HAP responded to the antimicrobial therapy. Conclusions HAP is a serious problem in RICU. The key to successful treatment of HAP is dependent on active prevention measures targe- ting high-risk groups; management of underlying dlseases, control of risk factors, environment optimization and antibiotic com- bination therapy.

关 键 词：医院获得性肺炎 呼吸科重症监护病房 危险因素 治疗 病原菌 

分 类 号：R563.1[医药卫生—呼吸系统]