新生儿呼吸机相关性肺炎的临床研究  

Clinical study on ventilator-associated pneumonia in neonates

作　　者：龚晓莉[1] 沈铭熙 褚旭丽[1] 

机构地区：[1]湖州市中心医院儿科,浙江湖州313000

出　　处：《中华医院感染学杂志》2014年第5期1273-1275,共3页Chinese Journal of Nosocomiology

基　　金：湖州市科技计划基金项目(2011YS18)

摘　　要：目的探讨新生儿呼吸机相关性肺炎(VAP)的病原菌感染特点及发生危险因素,提出相应的干预对策,为控制及降低新生儿VAP的发生提供参考依据。方法回顾性分析2011年11月-2012年11月医院新生儿重症监护病房128例行机械通气时间≥48h的患儿临床资料,分析病原菌感染特点及发生感染的危险因素,采用SPSS17.0统计软件进行统计分析,多因素分析采用非条件logistic回归分析。结果 128例患儿中共有42例发生VAP,发生率32.81%;呼吸道分泌物送检标本58例,培养阳性率90.48%,检出病原菌48株,其中革兰阴性菌45株占93.75%,主要为肺炎克雷伯菌、鲍氏不动杆菌,分别占44.19%、25.58%,革兰阳性菌2株占4.17%,真菌1株占2.08%;单因素分析,新生儿发生VAP与胎龄小、出生体质量低、原发疾病为呼吸系统疾病、新生儿出生时1min Apgar评分低、气管插管次数多、机械通气时间长、住院时间长等因素有关,非条件logistic多因素回归分析显示,小胎龄、低出生体质量、1min Apgar评分、气管插管次数多、机械通气时间及住院时间长,是引起新生儿发生VAP的独立危险因素。结论新生儿VAP发生率较高,感染病原菌以革兰阴性菌为主,引起感染的危险因素较多,应针对存在的危险因素进行有效干预以控制与降低VAP的发生。OBJECTIVE To explore the distribution of pathogens causing ventilator-associated pneumonia （V AP） in neonates and analyze the risk factors and put forward corresponding intervention measures to reduce the incidence of V AP in the neonates. METHODS A total of 128 neonates, who underwent the mechanical ventilation for more than 48 hours from Nov 2011 to Nov 2012, were enrolled in the study, then the clinical data of the neonates were retrospectively analyzed, the distribution of pathogens causing infections and the risk factors were analyzed, the statistical analysis was performed with the SPSS17. 0 software, and the non-conditional multivariate logistic regression analysis was conducted. RESULTS Of the 128 neonates, the YAP occurred in 42 cases with the incidence rate of 32. 81 %. The submitted respiratory tract secretions were collected from 58 cases with the positive rate of culture of 90. 48%, totally 48 strains of pathogens were isolated, including 45 （93.75%） strains of gram-negative bacteria, 2 （4. 17 %） strains of gram-positive bacteria, and 1 （2. 08 %） strain of fungi. The Klebsiella pneumoniae and Acinetobacter baumannii were the predominant species of gram-negative bacteria, accounting for 44. 19 % and 25.58%, respectively. The univariate analysis indicated that the incidence of YAP in the neonates was related to the short gestational age, low birth weight, respiratory system diseases as the primary disease, low 1 min Apgar score at birth, frequent endotracheal intubation, long mechanical ventilation and long length of hospital stay. The non-conditional multivariate logistic regression analysis showed that the short gestational age, low birth weight, 1 min Apgar score, frequent endotracheal intubation, long mechanical ventilation, and long length of hospital stay were the independent risk factors for V AP in the neonates. CONCLUSION The incidence of V AP is high in the neonates. The gram-negative bacteria are the predominant pathogens causing infections. There are a variety of risk factor

关 键 词：呼吸机相关性肺炎 新生儿 病原菌 危险因素 干预 

分 类 号：R722.13[医药卫生—儿科]