机械通气脑病患者呼吸机相关肺炎的病原菌分布和危险因素分析  

Analysis of pathogenic bacteria distribution and risk factors of ventilator associated pneumonia in encephalopathy patients with mechanical ventilation

作　　者：黄玉萍[1] 黄敏燕[1] 谢晓梅 张秋萍 虞丹[1] 刘素芝[1] HUANG Yu-ping;HUANG Min-yan;XIE Xiao-mei;ZHANG Qiu-ping;YU Dan;LIU Su-zhi(Taizhou Hospital of Zhejiang Province,Taizhou Zhejiang 317000,China)

机构地区：[1]浙江省台州医院,浙江台州317000

出　　处：《中国消毒学杂志》2018年第11期847-849,共3页Chinese Journal of Disinfection

基　　金：浙江省中医药科技计划(2012ZB177);台州市科技局科技计划(2014A33019)

摘　　要：目的研究机械通气脑病患者呼吸机相关肺炎的病原菌分布和危险因素。方法通过回顾性分析方法,对某医院住院实施气管插管机械通气脑卒中患者呼吸机相关肺炎(VAP)的病原菌分布及危险因素进行分析。结果共调查分析实施气管插管机械通气脑卒中患者148例,发生VAP患者59例,发生率为39. 86%。从59例VAP患者送检的标本中,共分离培养出病原菌73株,其中革兰阴性菌、革兰阳性菌和真菌构成比分别为63. 01%、28. 77%和8. 22%。Logistic回归分析结果显示,高龄、机械通气时间> 72 h、意识障碍、合并慢阻肺、APACHE-II评分≥15分等因素构成机械通气脑病患者感染VAP的独立危险因素。结论实施气管插管机械通气的脑病患者VAP主要为革兰阴性菌感染,其危险因素明确,应有针对性地采取防控措施。Objective To study the pathogenic bacteria distribution and risk factors of ventilator associated pneumonia in encephalopathy patients with mechanical ventilation. Methods By retrospective analysis,the pathogenic bacteria distribution and risk factors of ventilator-associated pneumonia（ VAP） in stroke patients undergoing endotracheal intubation and mechanical ventilation were analyzed. Results Among 148 patients,59 patients had ventilator-associated pneumonia,and the incidence was 39. 86%. Among these 59 patients,there were 73 strains of pathogenic bacteria,21 strains Gram-positive bacteria（ 28. 77%）,46 strains Gram-negative bacteria（ 63. 01%）,and 6 strains fungi（ 8. 22%）. The results of logistic regression analysis showed that advanced age,mechanical ventilation time 72 h,disturbance of consciousness,chronic obstructive pulmonary disease,APACHE-II scores 15 points were the risk factors of ventilator associated pneumonia（ OR 1,P 0. 05） in encephalopathy patients. Conclusion The pathogenic bacteria of ventilator related pneumonia in encephalopathy patients with mechanical ventilation are mainly Gram-negative bacteria. Its risk factors are clear,and targeted measures should be taken for prevention.

关 键 词：脑卒中 气管插管 呼吸机相关肺炎 病原菌 危险因素 

分 类 号：R378[医药卫生—病原生物学]