新生儿呼吸机相关性肺炎66例临床分析与预防对策  

Clinical analysis of 66 neonatal ventilator-associated pneumonia and prophylactic strategy

作　　者：祝伟[1] 张成云[1] 张念陪[1] 

机构地区：[1]郑州市第一人民医院儿科,450004

出　　处：《中国实用医刊》2013年第12期16-18,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨新生儿重症监护病房（NICU）中呼吸机相关性肺炎（VAP）的病原菌组成及相关因素，为临床防治抄供依据。方法分析66例NICU确诊的VAP患儿的临床资料及下呼吸道分泌物细菌培养的结果。结果VAP的发生率为50．77％；66例患儿共检出91株致病菌，其中革兰阴性菌69株（75．82％），革兰阳性菌13株（14．29%），真菌9株（9．89％）；铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯杆菌和白色念珠菌是VAP的主要致病菌；药敏结果显示感染菌株多重耐药，肠杆菌科革兰阴性菌对碳青霉烯类抗生素无一耐药，非发酵菌革兰阴性菌对常用的抗生素均具有较高的耐药性，革兰阳性菌对万古霉素无一耐药。结论NICU内VAP病原菌以革兰阴性菌为主，真菌比例较高，混合致病菌感染比例高；积极预防和治疗可以有效降低VAP的发生。Objective To investigate the compose and correlative factors of pathogens leading to ventilator-associated pneumonia（VAP） in neonatal intensive care units（NICU）, so as to provide evidences for clinical therapy. Methods The clinical data and the results of bacteria culture from the secretion of lower respiratory tracts of 66 cases of VAP in NICU were analyzed. Results The VAP incidence rate was 50.77%. 91 stains of pathogens were separated from 66 patients. In these pathogens, there were 69 strains of gram negative bacteria, 13 strains of gram positive bacteria and 9 strains of fungi. The main pathogens of VAP included pseudomonas aeruginosa, staphylococcus, klebsiella pneumoniae, candidiasis albicans. Susceptibility test results showed that most pathogens were multi-drug resistant. No enterobacteriaeeae had drug-resistance to carbopenems. Nonfermenters had a high drug-resistance to many widely-used antibiotics. Gram positive bacteria had no drug-resistance to vancomysin. Conclusions The main pathogens of VAP in NICU were gram negative bacteria. The rate of fungus and multiple bacte- rial infections was high. The combined treatment was necessary constitution for control of VAP.

关 键 词：新生儿 呼吸机相关性肺炎 临床分析 预防对策 

分 类 号：R722.1[医药卫生—儿科]