新生儿重症监护室出生胎龄＜34周早产儿呼吸机相关肺炎的多中心流行病学调查  

Ventilator-associated pneumonia among premature infants 〈 34 weeks＇ gestational age in neonatal intensive care unit in China： a multicenter study

作　　者：李淑涓 蒋思远[1] 张羿[2] Shoo K. Lee 严卫丽[2] 周琦[1] 韩树萍[4] 郭金珍 夏世文[6] Vibhuti Shah 王三南[1] 冀湧[1] 杨长仪[1] 杨传忠[1] 单若冰[1] 刘玲[1] 易彬[1] 刘江勤[1] 林振浪[1] 王杨[1] 何玲[1] 李明霞[1] 潘新年[1] 郭艳[1] 陈玲[1] 刘翠青[1] 周勤[1] 李晓莺[1] 熊虹[1] 齐宇洁[1] 黑明燕[1] 曹云[1] 

机构地区：[1] 复旦大学附属儿科医院新生儿科, 上海201102 [2] 复旦大学附属儿科医院临床流行病学研究室, 上海201102 [3] 加拿大多伦多大学Mount Sinai医院 [4] 南京市妇幼保健院新生儿科 [5] 西北妇女儿童医院新生儿科 [6] 湖北省妇幼保健院新生儿科

出　　处：《中华儿科杂志》2017年第3期182-187,共6页Chinese Journal of Pediatrics

基　　金：中华医学基金会（CMB）基金（14-194）

摘　　要：目的 调查我国新生儿呼吸机相关肺炎（VAP）的流行病学资料及病原菌分布特点.方法 分析2015年5月至2016年4月全国25家医院三级新生儿重症监护室（NICU）收治的出生胎龄＜34周所有患儿的临床资料,根据医院性质分组为儿童专科医院和妇婴医院或综合性医院,计算VAP发生率.采用x2检验,t检验或秩和检验进行统计学分析.结果 共纳入患儿7 918例,其中男4 623例（58.4％）,出生体重为（1 639 ±415）g,出生胎龄为（31.4±2.0）周,4 654例（58.8％）接受无创通气,2 154例（27.2％）接受有创机械通气.发生VAP 95例,总的VAP发生率为7.0/1 000个呼吸机使用日,各研究单位VAP发生率为（0-34.4）/1 000个呼吸机使用日.根据医院性质分组,7家儿童专科医院与18家妇婴医院或综合性医院VAP发生率差异无统计学意义[（9.6比6.0）/1 000个呼吸机使用日,t=1.002,P=0.327].检出病原菌83株,以革兰阴性杆菌（76株,91.6％）最常见,主要为鲍曼不动杆菌（24株,28.9％）,肺炎克雷伯杆菌（23株,27.7％）及铜绿假单胞菌（10株,12.0％）.结论 我国NICU平均VAP发生率接近发达国家水平,但不同医院之间差异显著,应加强各NICU医院内感染的定期监测和分析,在此基础上实施有效的感染综合防治措施,降低VAP发生率.Objective To investigate the incidence and pathogen distribution of ventilatorassociated pneumonia （VAP） among preterm infants admitted to level Ⅲ neonatal intensive care units （NICU） in China.Method A prospective study was conducted in 25 level Ⅲ NICU,enrolling all preterm infants 〈 34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016.Chi-square test,t test and Mann-Whitney U test were used for statistical analysis.Result A total of 7 918 patients were enrolled,within whom 4 623 （58.4%） were males.The birth weight was （1 639 ± 415） g and the gestational age was （31.4 ± 2.0） weeks;4 654 （58.8%） infants required non-invasive mechanical ventilation and 2 154（27.2%） required intubation.Of all the mechanically ventilated patients,VAP occurred in 95 patients.The overall VAP rate was 7.0 episodes per 1 000 ventilator days,varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers.The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children＇s hospitals and maternity-infant hospitals respectively,without significant differences （t =1.002,P =0.327）.Gram-negative bacilli （76 strains,91.6%） were the primary VAP microorganisms,mainly Acinetobacter baumannii （24 strains,28.9%）,Klebsiella pneumonia （23 strains,27.7%）,and Pseudomonas aeruginosa （10 strains,12.0%）.Conclusion The incidence of VAP in China is similar to that in developed counties,with substantial variability in different NICU settings.More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

关 键 词：婴儿 新生 肺炎 呼吸机相关性 多中心研究 病原学 

分 类 号：R722.6[医药卫生—儿科]