新生儿呼吸机相关肺炎的危险因素与病原菌研究  

Analysis of the risk factors and microbial causes for ventilator-associated pneumonia in newborns

作　　者：严纯雪[1] 陈园妹[2] 贾玉双[3] 张楚南[3] 潘国权[3] 

机构地区：[1]浙江省温州医学院附属育英儿童医院IC,325003 [2]浙江工业大学医院 [3]浙江省温州医学院附属育英儿童医院ICU,325003

出　　处：《河南诊断与治疗杂志》2002年第2期81-83,共3页Henan Journal of Diagnosis and Therapy

摘　　要：目的:探讨新生儿机械通气相关肺炎(ＶＡＰ)的危险因素及病原菌。方法:选取新生儿机械通气时间≥４８ｈ患儿１８０例,符合ＶＡＰ诊断标准７３例作为ＶＡＰ感染组,ＶＡＰ未感染组作为对照组,采用单因素分析ＶＡＰ的危险因素;并对ＶＡＰ作病原菌分析。结果:ＶＡＰ发生率４０．５６%。单因素分析表明低体重儿及早产儿,机械通气时间＞５ｄ,肺部原有疾病、有胃内容物吸入、鼻饲、使用胃酸抑制剂/抗酸剂是ＶＡＰ的危险因素,而机械通气时患儿头部位置抬高＞３０°及大剂量静脉注射丙种球蛋白能预防ＶＡＰ的发生;预防性使用抗生素不能降低ＶＡＰ的发生。病原学以Ｇ－菌为主,但Ｇ＋菌发生率显著上升,前５位依次为克雷白菌属、铜绿假单胞杆菌、金葡菌、肠杆菌属、不动杆菌属。结论:避免ＶＡＰ的危险因素,使用大剂量静脉注射丙种球蛋白能降低ＶＡＰ的发生率。ve To investigate the risk factors and microbial causes related to the development of ventilator- associated pneumonia(VAP). Methods A total of 180 intubated newborns for longer than 48 hours in Yuying Pediatrics Hospital were studied and divided into VAP group(73 cases) and non VAP group. Microbial causes of VAP were analyzed. Results The incidence of VAP was 40. 56%. Premature birth and low-birth-weight over 5 days ventilation,primary pulmonary diseases, enteral feeding, H2 receptor antiagonist and antacids were independently factors of VAP. It is useful for preventing VAP to the head of the baby and use a large dose of intravenous immunoglobulin. Preventive antimicrobial usage can not decrease the morbidity of VAP. The most frequently isolated organisms were Klebsiella species, Pseudomonas aeruginosa, Staphylococcus aureus,Enterobacteriaceae,Acinetobacter species. Conclusions It is suggested that a large dose of intravenous immunoglobulins might be useful in both preventing and treating VAP.

关 键 词：新生儿 呼吸机相关肺炎 危险因素 机械通气 病原菌 VAP 

分 类 号：R722.135[医药卫生—儿科]