慢性阻塞性肺疾病无创机械通气患者痰培养分析  

Sputum culture for chronic obstructive pulmonary disease patients undergoing non-invasive mechanical ventilation

作　　者：宋方芳[1] 应利君[1] 钟可芳[1] 王颖[1] 

机构地区：[1]绍兴市人民医院呼吸内科,浙江绍兴312000

出　　处：《中华医院感染学杂志》2014年第21期5322-5324,共3页Chinese Journal of Nosocomiology

基　　金：绍兴市科技基金资助项目(2008A23005)

摘　　要：目的：了解慢性阻塞性肺疾病（COPD）无创机械通气患者感染细菌的分布及耐药性，为临床治疗护理提供依据。方法回顾性调查2011年6月-2012年6月60例应用无创机械通气的COPD患者痰培养结果，采用法国生物梅里埃公司VITEK-2 Compact全自动微生物分析仪进行细菌鉴定和药敏试验，采用SPSS13．0软件对各数据进行统计分析。结果60例COPD无创机械通气患者痰培养阳性40例，阳性率66．7％，检出病原菌以革兰阴性菌为主，主要为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌，分别占37．5％、17．5％、12．5％，且对多种抗菌药物耐药，肺炎克雷伯菌、铜绿假单胞菌及鲍氏不动杆菌对抗菌药物的耐药率分别为为0～60．0％、0～28．0％、20．0％～100．0％。结论 COPD无创机械通气患者应采取综合防治措施，加强呼吸机管路及呼吸道的护理管理，实施有效的消毒隔离措施，严格执行无菌操作技术，加强对病原菌的监测，合理应用抗菌药物，以提高临床疗效。OBJECTIVE To understand the distribution and drug resistance of the pathogens causing infections in the chronic obstructive pulmonary disease （COPD） patients undergoing non-invasive mechanical ventilation so as to provide guidance for clinical nursing and treatment .METHODS A retrospective survey was conducted for the results of sputum culture of 60 COPD patients who underwent the non-invasive mechanical ventilation from Jun 2011 to Jun 2012 ,then the bacterial identification and the drug susceptibility testing were performed by using VITEK-2 Compact automatic microorganism analyzer of BioMerieux ,France ;the data were statistically analyzed with the use of SPSS13 .0 software .RESULTS The sputum specimens were cultured positive in 40 of 60 COPD patients undergoing the non-invasive mechanical ventilation ,with the positive rate of 66 .7% .The gram-negative bacteria were the predominant pathogens isolated ,among which the K lebsiella pneumoniae ,Pseudomonas aerugi-nosa ,and Acinetobacter baumannii were dominant ,accounting for 37 .5% ,17 .5% ,and 12 .5% ,respectively ;the strains were resistant to multiple antibiotics ,and the drug resistance rate of the K .pneumoniae ranged from 0 to 60 .0% ,the P .aeruginosa from 0 to 28 .0% ,the A .baumannii from 20 .0% to 100 .0% .CONCLUSION It is necessary for the COPD patients undergoing the non-invasive mechanical ventilation to take comprehensive prevention measures ,strengthen the nursing of the ventilator＇s pipelines and respiratory tracts ,carry out effective disinfection and isolation measures , strictly execute the aseptic operations , enhance the monitoring of the pathogens ,and reasonably use antibiotics so as to improve the clinical efficacy .

关 键 词：无创机械通气 慢性阻塞性肺疾病 痰培养 病原菌 耐药性 

分 类 号：R563[医药卫生—呼吸系统]