呼吸机相关性肺炎患儿病原菌分布与血清炎症因子的研究  

Distribution of pathogenic bacteria in patients with ventilator associated pneumonia and serum inflammatory factors

作　　者：黄梦[1] 徐旭[1] 章国忠[1] 李克诚[1] 林洁[1] 

机构地区：[1]温州医科大学附属第三医院瑞安市人民医院儿科,浙江瑞安325200

出　　处：《中华医院感染学杂志》2016年第3期665-667,共3页Chinese Journal of Nosocomiology

基　　金：浙江省温州科技局基金资助项目(Y20140269)

摘　　要：目的探讨呼吸机相关性肺炎(VAP)患儿病原学特点,并分析患者血清炎性因子表达变化,以指导临床预防治疗疾病。方法回顾性分析2009年1月-2014年12月重症监护病房行机械通气133例患儿临床资料,按VAP诊断结果,将28例VAP患儿分为观察组,105例非VAP患儿分为对照组,采集观察组患儿痰液或下呼吸道分泌物,行病原菌培养及药敏检测,明确病原菌构成、耐药性;动态检测所有患儿血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8水平,数据采用SPSS19.0软件进行统计处理对比分析。结果 133例患儿中28例发生VAP,发生率为21.1%;VAP患儿中共检出病原菌105株,其中革兰阴性菌86株占81.9%,革兰阳性菌17株占16.2%,真菌2株占1.9%;鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对头孢西丁的耐药率最高,分别为95.8%、90.0%、100.0%;急性期TNF-α、IL-6及IL-8显著升高,病情好转后明显下降,但仍明显高于对照组,组间比较差异均有统计学意义(P<0.05)。结论重症监护病房行机械通气患儿VAP发病率较高,应准确掌握其病原菌及相关耐药性;血清炎性因子有助于反应疾病病情,值得关注。OBJECTIVE To investigate the pathogenic characteristics of patients with ventilator associated pneumonia（VAP）,and to analyze the changes of serum inflammatory factors in these patients so as to guide clinical prevention and treatment of the disease.METHODS A retrospective analysis was conducted on the clinical data of 133 children undergoing mechanical ventilation in the pediatric ICU during Jan.2009 to Dec.2014.According to the diagnostic results,28 cases of VAP children were set into the observation group and 105 cases of non VAP children were set into the control group.Sputum or secretions of lower respiratory tract were sampled from the observation group for pathogenic bacterial culture and drug sensitive test to clarify the constitution of the pathogenic bacteria and the drug resistance.Dynamic detection of serum tumor necrosis factor alpha（TNF-α）,interleukin 6（IL-6）and interleukin 8（IL-8）levels was conducted for all children.Data were statistically processed by software SPSS19.0for comparative analysis.RESULTS There were 28 VAP cases in the 133 children with the incidence of21.1%.Totally 105 pathogenic strains were detected,including gram-negative bacteria（86strains,81.9%）,gram-positive bacteria（17strains,16.2%）and fungi（2strains,1.9%）.The resistances of Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae were the highest to cefoxitin,being 95.8%,90.0%and 100.0%.IL-6,IL-8and TNF-αwere significantly increased in the acute phase and reduced when symptoms were improved,which,however,were significantly higher compared to the control group（P 0.05）.CONCLUSION The incidence of VAP is high in children undergoing mechanical ventilation in pediatric ICU,and it is necessary to understand the pathogens and the relative resistance of VAP.Attention should be paid to serum inflammatory factors as they are helpful to reflect the disease condition.

关 键 词：儿科 呼吸机相关性肺炎 病原菌 血清炎症因子 

分 类 号：R563.1[医药卫生—呼吸系统]