新生儿呼吸机相关性肺炎病原菌及其预后的分析  

Analysis of pathogens and prognosis of neonatal ventilator-associated pneumonia

作　　者：刘绍先[1] 梁中信[1] 王宝平[1] LIU Shao-xian;LIANG Zhong-xin;WANG Bao-ping(First Department of Pediatrics, People′s Hospital of Langfang, Hebei Province, Langfang 065000, China)

机构地区：[1]河北省廊坊市人民医院儿一科,河北廊坊065000

出　　处：《河北医科大学学报》2020年第6期646-649,共4页Journal of Hebei Medical University

摘　　要：目的探究新生儿呼吸机相关性肺炎(ventilator associated pneumonia,VAP)病原菌的耐药性及病原菌对预后的影响。方法选取65例VAP新生儿为VAP组,并选取同期住院应用机械通气治疗但未合并VAP的新生儿65例为非VAP组。对VAP组新生儿气管内分泌物培养和药物敏感试验,分析致病菌感染情况和短期预后。结果65例VAP新生儿分泌物培养出病原菌49株,且检测结果显示所培养出的均是革兰阴性菌,占比最多的肺炎克雷伯菌为30.61%,其次是大肠埃希菌占28.57%,鲍氏不动杆菌占20.41%,这三种菌对头孢菌素类抗菌药物耐药性均达到100%,对阿米卡星、亚胺培南、环丙沙星等抗菌药物较为敏感。插管时及每隔1 d检测后,两组新生儿的临床肺部感染评分逐渐降低,且VAP组显著高于非VAP组(P<0.05);VAP组机械通气时、NICU住院时间以及总体住院时均显著大长非VAP组(P<0.05),且前者的病死率高于VAP组(P<0.05)。结论VAP新生儿合并耐药菌感染,患儿在接受抗感染治疗时会出现疗效不佳、机械通气和住院时间更多等情况,而患儿病死率也呈现升高趋势。实际诊治中还需根据检测结果针对性予以敏感抗菌药物,在一定程度上控制病原菌的耐药性,提高治愈率。Objective To investigate the drug resistance of pathogenic bacteria in neonatal ventilator-associated pneumonia ventilator associated pneumonia(VAP)and the effect of pathogenic bacteria on prognosis.Methods Sixty-five neonates with ventilator-associated pneumonia hospitalized in our hospital were divided into VAP group and 65 neonates who were hospitalized with mechanical ventilation but not complicated with VAP were selected as non-VAP group.The culture of endotracheal secretions and drug sensitivity test in VAP group were used to analyze the infection and short-term prognosis of pathogenic bacteria.Results Forty-nine strains of pathogenic bacteria were cultured from the secretion of 65 VAP newborns,and the results showed that all of them were Gram-negative bacteria.The proportion of species was 30.61%for Klebsiella pneumoniae,28.57%for Escherichia coli,and 20.41%for Acinetobacter baumannii.The resistance of these three kinds of bacteria to cephalosporins and amikacin was 100%Antibiotics such as imipenem,ciprofloxacin are more sensitive.During intubation and every day after detection,the clinical pulmonary infection score of the two groups decreased gradually,and the VAP group was significantly higher than that of the non VAP group(P<0.05);according to the results,the duration of mechanical ventilation,the length of hospitalization of NICU and the overall length of hospitalization in the VAP group were significantly longer than that in the non VAP group(P<0.05),and the mortality of the former was significantly higher than that in the non VAP group(P<0.05).Conclusion VAP newborns with drug-resistant bacteria infection,children in the treatment of anti infection will have poor efficacy,mechanical ventilation and more time needed for hospitalization,and the mortality rate of children also showed an increasing trend.In the actual diagnosis and treatment,it is necessary to give sensitive antibiotics according to the test results,control the drug resistance of pathogenic bacteria to a certain extent,and improve the cu

关 键 词：肺炎 呼吸机相关性 婴儿 新生 预后 

分 类 号：R639[医药卫生—外科学]