重症监护室老年患者呼吸机相关肺炎危险因素及病原学研究  

Analysis of pathogen and risk factors of elderly patients with ventilator-associated pneumonia in ICU

作　　者：郭金玲[1] 张长春[1] 田洋洋[1] 

机构地区：[1]中国人民解放军第306医院重症监护室,北京100101

出　　处：《临床急诊杂志》2015年第9期701-704,共4页Journal of Clinical Emergency

摘　　要：目的:探讨重症监护室老年患者呼吸机相关肺炎(VAP)发生的危险因素,并对病原菌进行分析。方法:回顾性分析2012-01-2014-12入住我院ICU的年龄大于60岁的气管插管或气管切开的机械通气患者的临床资料。结果:APACHEⅡ评分≥15分、机械通气时间≥7d及使用抑酸药物>3d是VAP发生的危险因素。细菌培养检出病原菌386株,其中革兰氏阴性菌302株(78.2%),革兰氏阳性菌45株(11.7%),真菌39株(10.1%),VAP感染的主要病原体为革兰氏阴性菌,且呈现多重耐药现象。结论:老年患者VAP的发生涉及多种危险因素,致病菌以革兰氏阴性菌为主,且耐药现象严重。为降低VAP的发生率,应对机械通气的患者进行全面预防,合理使用抗生素。Objective：To investigate the risk factors for elderly patients with ventilator-associated pneumonia in ICU and analyze the pathogenic bacterium.Method：The clinical data of elderly patients with tracheal intubation or tracheotomy for mechanical ventilation in ICU of our hospital from January 2012 to December 2014 were analyzed retrospectively.Result：The score of APACHEⅡ≥15,the artificial mechanical ventilation time（≥7day）and the using time of antacid3days were the risk factors in VAP.Totally 386 strains of pathogens have been isolated,of them 302 strains were gram-negative bacilli,accounting for 78.2%,45 strains were gram-positive bacilli,accounting for 11.7%,39 strains were fungi,accounting for 10.1%.The major pathogens in VAP were Gram-negative bacilli and they were often multiple drug resistant.Conclusion：VAP in elderly patients involves multiple risk factors,the main pathogenic bacteria is gram-negative bacilli,and drug resistance is serious.In order to reduce the incidence of VAP,a comprehensive prevention and rational use of antibiotics were advocated.

关 键 词：呼吸机相关肺炎 危险因素 病原菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]