重症监护室机械通气患儿呼吸道病原学特点分析  

Analysis of the Characteristic of Pathogenic among Children on Mechanical Ventilation in PICU

作　　者：周海银[1] 曾晓辉[1] 王兴勇[2] 卢秀兰[1] 仇君[1] 

机构地区：[1]湖南省儿童医院,湖南长沙410001 [2]重庆医科大学附属儿童医院,重庆400014

出　　处：《儿科药学杂志》2015年第12期34-36,共3页Journal of Pediatric Pharmacy

基　　金："十二五"国家科技支撑计划;项目编号2012BAI04B01

摘　　要：目的:了解儿科重症监护室(PICU)机械通气患儿的基础疾病与呼吸道病原菌的分布、变化及药敏特点,以指导临床治疗。方法:选择2012年湖南省儿童医院PICU机械通气患儿107例,收集深部痰标本进行病原菌培养,根据患儿年龄、性别、基础疾病、机械通气时间、预后等资料,分析病原菌的分布、变化及药敏特点。结果:107例患儿共检出菌株总数为220株,其中革兰阴性菌152株(69.1%),以不动杆菌属、肺炎克雷伯菌、铜绿假单胞菌为主;真菌53株(24.1%),以白色念珠菌为主;革兰阳性菌15株(6.8%),以链球菌属、金黄色葡萄球菌为主。随着通气时间延长,真菌感染率逐渐上升。革兰阴性菌对青霉素类、头孢菌素类耐药严重,对美罗培南敏感;革兰阳性球菌对美罗培南、万古霉素敏感;真菌对氟康唑、伏立康唑、两性霉素B、5-氟胞嘧啶敏感。结论:PICU机械通气患儿呼吸道病原菌以革兰阴性菌为主,真菌感染率随着通气时间的延长而上升;病原菌耐药情况严重,应根据病原菌培养结果选用合适抗菌药物以避免耐药问题加重。Objective： To know the characteristic of underlying diseases,distribution and drug sensitive of pathogenic among mechanical ventilation children in pediatric intensive unit care,and guide clinical therapy. Methods： A total number of 107 children（ ≤18 years） on mechanical ventilation were selected from pediatric intensive care unit in Hunan Children＇s Hospital in 2012 in the study. The sputum samples of deep part were collected,the distribution and drug sensitive of pathogenic were analyzed according to age,sex,underlying diseases,the length of mechanical ventilation and the outcomes. Results： Two hundreds and twenty strains of pathogenic bacteria were cultured from 107 cases. The number of Gram-positive bacteria was 152（ 69. 1%） strains,the fungus was 53（ 24. 1%）strains,and the Gram-negative bacteria was 15 strains（ 6. 8%）. The primary Gram-positive bacteria included Staphylococcus aureus and Streptococci,the primary Gram-negative bacteria included Acinetobacter,Klebsiella pneumonia and Peudomonas aeruginosa,the primary fungus was Candida albicans. The infection of fungal was increased while the time of mechanical ventilation was prolonged. The Grampositive bacteria showed drug resistance to meropenem and vancomycin. The Gram-negative bacteria showed drug resistance to penicillin and cephalosporin antibiotics. Conclusion： The main pathogen was Gram-negative bacteria in pediatric children with mechanical ventilation. The infection of fungal was increased while the time of mechanical ventilation was prolonged. Whatever the bacteria,the condition of drug resistance was serious. Therefore,based on the pathogens,the most suitable antibiotic should be selected in pediatric patients with mechanical ventilation in order to reduce the condition of drug resistance.

关 键 词：儿科 重症监护室 机械通气 病原菌 耐药谱 

分 类 号：R720.597[医药卫生—急诊医学]