临床肺部感染评分对重症监护病房机械通气患者下呼吸道检出多重耐药菌的临床分析  

Analysis on the clinical pulmonary infection score on the detection of multidrug resistance organisms in lower respiratory tract in ventilated patients in intensive care unit

作　　者：刘欢[1] 

机构地区：[1]广西医科大学第四附属医院ICU,柳州545005

出　　处：《中国危重病急救医学》2012年第11期680-682,共3页Chinese Critical Care Medicine

基　　金：广西自然科学基金（0229030）

摘　　要：目的调查重症监护病房（ICU）机械通气患者下呼吸道检出多重耐药菌（MDR）时，不同临床肺部感染评分（CPIS）患者MDR的构成特点、检出时间、病死率。方法采用回顾性研究方法，收集2010年4月至2011年12月ICU机械通气〉48h且下呼吸道检出MDR的72例患者临床资料，同时进行CPIS评分，其中CPIS评分〉6分即被诊断为呼吸机相关性肺炎（VAP）33例，CPIS评分≤6分39例（非VAP），比较两组患者MDR的构成特点、检出时间及病死率。结果VAP组MDR主要以鲍曼不动杆菌（49．5％（34／74）]为主，其次为肺炎克雷伯菌（24.3％（18／74）]、大肠埃希菌（20.3％（15／74）]、铜绿假单胞菌[5．4％（4／74）]、耐甲氧西林金黄色葡萄球菌[MRSA，4．1％（3／74）]；非VAP组以大肠埃希菌[40．2％（37／92）]为主，其次为铜绿假单胞菌[33．7％（31／92）]、肺炎克雷伯菌[13．1％（12／92）]、鲍曼不动杆菌[8．7％（8／92）]、MRSA（4.3％（4／92）]。VAP组MDR平均检出时间（d）与非VAP组比较差异无统计学意义（10．7±1．5比9．4±1．8，P〉0．05）；VAP组病死率明显高于非VAP组（39．4％比23．1％，P〈0．05）。结论ICU机械通气患者无论是否发生VAP，下呼吸道均可能检出不同MDR，并不同程度地影响患者预后，应密切监测，并适当初始经验性或动态调整抗菌药物的治疗策略。Objective To investigate the characteristics of muhidrug resistance （MDR） organisms from the lower respiratory tract in ventilated patients, and the constitution, detection time and mortality of the intensive care unit （ICU） patients with different clinical pulmonary infection scores （CPIS）. Methods A retrospective study was conducted. The clinical data of 72 cases with lower respiratory tract MDR on ventilation more than 48 hours were collected from April 2010 to December 2011. CPIS were calculated at the same time. Thirty-three patients with CPIS〉6 were diagnosed as ventilation associated pneumonia （VAP）, while 39 having CPIS ≤ 6 （non-VAP）. The characteristics of MDR, the detection time and mortality of the patients were compared between the two groups. Results The first five MDR were Baumanii [49.5%（34/74）], Klebsiella pneumoniae [24.3%（ 18/74）], Escherichia eoli [20.3%（15/74）], Pseudomonas aeruginosa [ 5.4% （4/74） ] and Methicillin-resistant Staphylococcus anrens [ MRSA, 4.1% （3/74） ] in VAP group, while the first five were Escherichia eoli [40.2% （ 37/92 ） ] Pseudomonas aeruginosa [ 33.7% （ 31/92 ） 3, Klehsiellapneumoniae [13.1%（12/92）], Baumanii [8.7%（8/92）] and MRSA [4.3%（4/92）] in non-VAP group. There was no significant difference in average detection time （days） between VAP group and non-VAP group （10.7 ± 1.5 vs. 9.4 ± 1.8, P〉0.05）. The mortality rate in VAP group was significantly higher than that in non-VAP group （ 39.4% vs. 23.1%, P〈0.05 ）. Conclusions Different MDR may be detected in lower respiratory tracts no matter the ventilated patients having VAP or not, which influence the patients prognosis and should be monitored intensively. Antibiotics should be empirically prescribed and adjusted dynamicly.

关 键 词：临床肺部感染评分 重症监护病房 机械通气 多重耐药菌 呼吸机相关性肺炎 

分 类 号：R459.7[医药卫生—急诊医学]