儿科机械通气相关肺炎的病原学探讨  

Pathogenic analysis of ventilator-associated pneumonia in pediatrics.

作　　者：施士德[1] 裘刚[1] 汤定华[1] 张弘[1] 滕国良[1] 张育才[1] 

机构地区：[1]上海市儿童医院,市儿童急救中心,上海200040

出　　处：《小儿急救医学》2002年第4期204-205,共2页Pediatric Emergency Medicine

摘　　要：目的　 分析下呼吸道定殖菌 ,探讨机械通气 (MV)相关肺炎 (VAP)的病原。 方法 　 1995～ 2 0 0 2年MV≥ 48h患儿按入院时间分为 3组 ,分析、比较气管插管内采样的下呼吸道定殖菌。 结果 　MV≥ 48h ,患儿 44 4例 ,VAP 15 9例 (3 5 8% ) ,采样标本 689例次 ,分离细菌 44 1株 ,铜绿假单胞菌为首位 ,克雷伯菌次之。近 2年 ,葡萄球菌第二位 ,产超β 内酰胺酶 (ESBLs)菌位第三。 结论 　VAP的病原学可能发生变迁 ,在经验用药时除了考虑铜绿假单胞菌感染外 ,还要警惕耐药葡萄球菌和产ESBLs菌的感染。Objective To explore the pathogens of ventilator associated pneumonia (VAP) in children.Methods The low airway excretions of 444 patients with mechanical ventilation (MV)≥ 48?h were collected through the endotracheal tube and bacteria were analyzed from 1995 to 2001.Results Among 444 cases,VAP were diagnosed in 159(35\^8%) patients.689 samples were collected and 441 strains of bacteria were isolated.The three leading bacteria colonized in pulmonary were Pseudomonas aeruginosa,Klebsiella and Staphylococcus,but in the two recent years,the three leading bacteria became Pseudomonas aeruginosa,Staphyloccoccus and ESBLs producing strains.Conclusion The pathogens of VAP appear alter in the recent years.The empirical treatment of VAP may include antistaphylococcus and antiESBLs producing strains in addition to using antipseudomonal.

关 键 词：机械通气 院内感染 病原学 儿童 VAP 呼吸机相关性肺炎 

分 类 号：R720.597[医药卫生—急诊医学]