口腔牙菌斑与呼吸机相关性肺炎的关系  

Relationship of dental plaque and ventilator associated pneumonia

作　　者：高伟良[1] 王凌伟[1] 吴伟元[1] 陶维华[1] 

机构地区：[1]暨南大学第二临床医学院(深圳市人民医院)呼吸科,广东深圳518020

出　　处：《临床荟萃》2015年第5期509-511,共3页Clinical Focus

基　　金：深圳市科技计划资助项目(201202120)

摘　　要：目的探讨机械通气患者口腔牙菌斑与呼吸机相关性肺炎(VAP)的关系。方法选择我院重症监护病房行机械通气后并发VAP的30例患者,同时取其口腔牙菌斑和肺泡灌洗液进行培养,并进行细菌鉴定和同源性分析。结果 30例患者中有22例的牙菌斑能培养出需氧细菌,其中15例的牙菌斑培养出的需氧菌≥2种;17例患者的肺泡灌洗液能培养出需氧细菌。牙菌斑和肺泡灌洗液培养出的革兰阴性菌的比例均高于革兰阳性菌。17个肺泡灌洗液样本中有10个和自身牙菌斑所培养出来的细菌具有高度同源性。结论口腔牙菌斑与VAP的发生密切相关,可能是机械通气患者呼吸道病原体的一个重要来源。Objective To investigate the relationship of dental plaque and ventilator associated pneumonia （VAP）in patients undergoing mechanical ventilation.Methods A total of 30 patients with VAP who were admitted into the intensive care unit of hospital were selected.Dental plaques and bronchoalveolar lavage fluids （BALF）samples from patients were cultured,the bacteria from the BALF and dental plaques were identified and homology analysis was determined by pulsed-field gel electrophoresis.Results Aerobic bacteria were cultured from 22 dental plaques of 30 patients,including 1 5 patients with equal to or greater than 2 kinds of bacteria;aerobic bacteria were cultured from 1 7 BALF samples.The proportion of gram-negative bacteria was higher than that of gram-positive bacteria isolating from both the dental plaques and BALF samples.Bacteria from 10 BALF samples showed highly homologous with those of dental plaques samples.Conclusion Dental plaques are closely related to VAP and may serve as important reservoir for respiratory pathogens in patients undergoing mechanical ventilation.

关 键 词：肺炎 呼吸机相关性 牙菌斑 

分 类 号：R563.1[医药卫生—呼吸系统]