机械通气患儿气管导管内生物被膜形成与呼吸机相关性肺炎的关系  

The characteristics of bacterial biofilm formation in endotracheal tubes in ventilated patients and the relationship between the biofilm and ventilator-associated pneumonia

作　　者：曲东[1] 任晓旭[1] 郭琳瑛[1] 徐文健[1] 梁金鑫[1] 韩晔华 祝益民[3] 

机构地区：[1]首都儿科研究所附属儿童医院重症医学科,北京100020 [2]中国医学科学院基础医学部,北京100730 [3]湖南省人民医院,长沙410005

出　　处：《中国小儿急救医学》2015年第4期237-240,共4页Chinese Pediatric Emergency Medicine

基　　金：“十二五”国家科技支撑计划（2012BAI04B00）

摘　　要：目的：研究机械通气患儿气管导管内生物被膜形态、病原学特点、耐药性及其与呼吸机相关性肺炎（ ventilator associated pneumonia,VAP）的关系。方法选取2010年9月至2012年9月在我院重症监护病房施行气管插管并机械通气≥48 h的患儿60例,按机械通气时间分为2-6 d组、7-14 d组和≥15 d组。通过前瞻性研究,比较不同组VAP发生率,电镜下生物被膜结构,下气道分泌物与生物被膜内病原学培养阳性率、病原学特点与耐药性。结果（1）60例患儿中发生VAP 19例次,VAP发生率31．7%；（2）电镜下,机械通气早期气管导管内壁即形成生物被膜,随着机械通气时间延长,生物被膜结构日益完善,VAP发生率由9．1%（2-6 d组）升高到44．4%（7-14 d组）和88．9%（≥15 d组）；（3）生物被膜内寄殖大量病原菌,以革兰阴性杆菌为主,且耐药性高；（4）随着机械通气时间延长,下气道分泌物培养与生物被膜内病原菌培养病原菌趋于一致。结论机械通气患儿气管导管内形成生物被膜,是VAP发生并导致难治性感染的一个重要因素。Objective To observe the formation of the biofilm in endotracheal tubes,the characteristics of etiology, drug resistance and relationship between the biofilm and ventilator-associated pneumonia （ VAP） . Methods A total of 60 cases of ventilated children patients whose mechanical ventilation time were≥48 h in the ICU from September 2010 to September 2012,according to the mechanical ventilation time,all cases were divided into 2 to 6 d group,7 to 14 d group and ≥15 d group. The incidence of VAP, biofilm structure under the electron microscope,etiology culture positive rate of the lower airway secretions and biofilm,etiological characteristics and drug resistance were prospectively studied. Results （ 1 ） A total of 19 cases occurred VAP in 60 cases of mechanical ventilation,the incidence of VAP was 31. 7%. （2） Observed by electron microscope,biofilm had formed in the endotracheal tube inner wall in early period of mechanical ventilation. With prolonged mechanical ventilation,biofilm structure had improved,as well as VAP incidence rate from 9. 1%（2 to 6 d group ） increased to 44. 4%（7 to 14 d group） and 88. 9%（≥15 d group）. （3） A large number of pathogenic bacteria colonized in the biofilm. Gram-negative bacilli were dominate and drug resistance was high. （4） With prolonged mechanical ventilation,the cultured pathogens from the lower airway secretions and biofilm converged. Conclusion Biofilm could form in the endotracheal tube with mechanical ventilation patients,and is associated with the occurrence of VAP and refractory infections.

关 键 词：气管导管 生物被膜 呼吸机相关性肺炎 病原菌 耐药性 

分 类 号：R725.6[医药卫生—儿科]