机械通气患者病原菌监测分析与呼吸机管路更换周期的研究  

Pathogenic bacteria in mechanical ventilation patients and replacement cycle of ventilator pipelines

作　　者：钟秀君[1] 顾克菊[2] 王雪文[2] 张谊[1] 汤杰[1] 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院呼吸科,上海200437 [2]上海中医药大学附属岳阳中西医结合医院医院感染管理科,上海200437

出　　处：《中华医院感染学杂志》2013年第2期288-290,共3页Chinese Journal of Nosocomiology

摘　　要：目的监测呼吸道和呼吸机管路中的细菌学特征,观察呼吸机管路更换对呼吸机相关性肺炎(VAP)、管路细菌生长的影响。方法将106例ICU机械通气患者随机分为A组和B组,分别予以2、7d更换呼吸机管路,两组患者在机械通气治疗24h时分别采集下呼吸道分泌物、呼气管路冷凝器、螺纹管呼气管接口端前10cm内壁标本,进行半定量细菌培养,之后每周行两次细菌学检测、1次X线胸片,观察下呼吸道、呼吸机管路病原菌检测结果和有无VAP发生,比较两组间有无差异。结果呼吸机管路中生长的细菌基本与下呼吸道分泌物一致,以革兰阴性杆菌为主,多药耐药菌所致的VAP占VAP发病总数64.71%,多药耐药菌株已占分离病原菌总株数的52.31%;A组发生VAP15例,感染率为28.30%,B组为19例,感染率为35.85%,两组差异无统计学意义;A组呼吸机管路细菌阳性24例,检出率为45.28%,B组阳性36例,检出率为67.92%,每2d更换管路可减少管路中细菌生长(P<0.05);106例机械通气患者死亡40例,52例多药耐药菌感染者死亡27例,高于一般机械通气患者(P>0.05)。结论对管路病原菌阴性的机械通气患者主张每7d更换1次管路,而对有致病菌感染患者主张每2d更换。OBJECTIVE To monitor the respiratory tract and ventilator tubing in the bacteriological characteristics, observe the effect of ventilator pipe replacement on ventilator-associated pneumonia （VAP） and the growth of bacteria on the pipelines. METHODS A total of 106 cases of mechanical ventilation patients in ICU were randomly divided into the group A and the group B respectively, the ventilator pipelines were replaced every 7/days and every 2/day respectively for the two groups. The specimens were sampled from the secretions from the lower respiratory tract, ventilator pipeline condenser ,and inner wall 10cm ahead from the interface of threaded pipe and expiratory pipe, then the semi-quantitative bacterial culture was performed, following it the bacterial examination was performed twice for every week, once for chest X-ray. The detection of the pathogens from the respiratory tract and the ventilator pipeline and the incidence of VAP were observed , and the differences between the two groups were compared. RESULTS The species of the bacteria from the ventilator pipeline were the same as those from the respiratory tract, the gram-negative bacilli were dominant. The patients with VAP caused by the muldrug-resistant bacteria accounted for 64. 71%, and the multidrug-resistant bacteria accounted for 52. 31% among all the pathogens isolated. There were 15 （28.30%） patients with VAP in the group A and 19 （35.85%） patients in the group B, the difference was not statistically significant. There were 24 （45.28%）cases in the group A with the bacteria tested positive from the ventilator pipelines and 36 （67.92%） cases in the group B. The replacement of pipelines every two days could reduce the growth of bacteria in the pipelines. There were 40 of 106 mechanical ventilation patients dead, 27 of 52 with multidrug-resistant bacteria infection dead, which were more than the general mechanical ventilation patients. CONCLUSION We advocate the 7d-replacement of the pipeline for the general mechanic

关 键 词：病原菌监测 呼吸机管路更换 呼吸机相关性肺炎 

分 类 号：R181.32[医药卫生—流行病学]