呼吸机相关性肺炎42例临床分析  

Clinical analysis on 42 cases of patient with ventilator-associated pneumonia

作　　者：杜永杰[1] 苏卫华[1] 张晓红[1] 刘瑞芳[1] 张玲[1] Du Yongjie, Su Weihua, Zhang Xiaohong, Liu Ruifang, Zhang Ling(Department of Respiratory Critical Care Medicine, People＇s Hospital of Linfen, Linfen 041000, Chin)

机构地区：[1]山西省临汾市人民医院呼吸危重医学科,041000

出　　处：《中国实用医刊》2018年第3期51-53,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨呼吸机相关性肺炎（VAP）的早期临床症状、高危因素、病原菌分布、治疗及预防措施.方法 回顾性分析310例机械通气患者中42例VAP患者的临床资料、致病菌及治疗方案等.结果 VAP发生率为13.5％,病死率为14.3％.VAP早期临床症状有发热、痰液增多、脓性痰液、呼吸困难、撤机困难等;高危因素包括：意识不清、误吸、低营养状态、糖皮质激素、质子泵抑制剂使用等.主要致病菌为革兰阴性杆菌（88.1％）,其中以鲍曼不动杆菌、肺炎克雷伯杆菌和铜绿假单胞菌为主;革兰阳性球菌在致病菌中占7.1％,主要为金黄色葡萄球菌;真菌在致病菌中占4.8％,为热带假丝酵母菌和曲霉菌.结论 对机械通气患者采取积极有效预防,及时有效应用抗菌药治疗和综合治疗,可以减少VAP发生率,降低病死率.Objective To investigate the early clinical symptoms,high-risk factors,pathogen distribution,treatment and preventive measures of ventilator-associated pneumonia （VAP）.Methods The clinical data,pathogens and treatment regimens of 42 VAP patients among the 310 patients with ventilation were retrospectively analyzed.Results Incidence of VAP was 13.5% and fatality rate was 14.3%.Early clinical symptoms of VAP included fever,sputum increasing,purulent sputum,dyspnea,weaning difficult and so on;high-risk factors included confusion,aspiration,low nutritional status,glucocorticoid,using proton pump inhibitor.The main pathogen was Gram-negative bacilli （88.1%）,of which Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were the predominants;Gram-positive cocci accounted 7.1% of pathogen,of which Staphylococcus aureus was the predominant;Fungi accounted 4.8% of pathogen,including Candida tropicalis and Aspergillus.Conclusions Taking active and effective prevention,timely performing antimicrobial therapy and comprehensive treatment for the patients with mechanical ventilation can reduce the incidence and fatality rate of VAP.

关 键 词：呼吸机相关性肺炎 高危因素 经验治疗 

分 类 号：R563.1[医药卫生—呼吸系统]