机械通气的重症肺炎患者管道中冷凝水污染情况分析  

Analysis of condensate contamination in pipelines of severe pneumonia patients undergoing mechanical ventilation

作　　者：孟照全 张朝贵[1] 王桂林[1] MENG Zhaoquan;ZHANG Chaogui;WANG Guilin(Department of Emergency,Second People’s Hospital of Yibin City,Yibin,Sichuan 644000,P.R.China)

机构地区：[1]宜宾市第二人民医院急诊科,四川宜宾644000

出　　处：《中国呼吸与危重监护杂志》2020年第6期582-585,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨机械通气的重症肺炎患者管道中冷凝水污染情况。方法连续性收集2017年1月至2019年1月我院收治的机械通气的重症肺炎患者120例,采集患者下呼吸道分泌物行细菌学检查。同时于气管插管并机械通气开始后4、8、12、16、20、24 h时分别采集呼吸机排气管中冷凝水行细菌学检查,分析不同时间点冷凝水中细菌污染情况以及与下呼吸道分泌物中细菌的一致性,并对冷凝水中细菌污染情况进行耐药性分析。结果120例机械通气的重症肺炎患者,102例下呼吸道分泌物培养出分离菌,其中88例培养出1株分离菌,10例培养出2株分离菌,4例培养出3株分离菌;共培养出120株,革兰阴性菌占57.5%,革兰阳性菌占42.5%;最常见的分离菌株为铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌。4 h时冷凝水中污染率为5.0%,8 h为37.5%,12 h为60.0%,16 h为76.7%,20 h为95.0%,24 h为100.0%,不同时间点冷凝水中细菌污染率整体比较有统计学意义(P=0.000),4 h污染率显著低于8 h(P=0.000);革兰阴性菌占57.5%,革兰阳性菌占42.5%;最常见的分离菌株为金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌。机械通气的重症肺炎患者下呼吸道中细菌与冷凝水中细菌一致性高达83.3%。铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌整体耐药性均较高,仅对亚胺培南/西司他丁耐药性较低。结论机械通气的重症肺炎患者冷凝水中细菌污染严重,尤以4 h后污染率较高,与下呼吸道中细菌污染的一致性较高,细菌整体耐药性较高。Objective To investigate the condensate pollution in the pipeline of severe pneumonia patients undergoing mechanical ventilation.Methods From January 2017 to January 2019,120 patients with severe pneumonia treated by mechanical ventilation in our hospital were collected continuously.The lower respiratory tract secretions were collected for bacteriological examination.At the same time,the condensed water in the ventilator exhaust pipe was collected for bacteriological examination at 4,8,12,16,20 and 24 hours after tracheal intubation and mechanical ventilation.The bacterial contamination in the condensed water at different time points was analyzed and separated from the lower respiratory tract.The consistency of bacteria in secretion and drug resistance analysis of bacterial contamination in condensate water were carried out.Results Of the 120 patients with severe pneumonia after mechanical ventilation,isolates were cultured in the lower respiratory tract secretions of 102 patients.One strain was cultured in 88 cases,two strains were cultured in 10 cases,and three strains were cultured in 4 cases.The isolates were mainly Gram-negative bacteria(57.5%)and Gram-positive bacteria(42.5%).The most common isolates were Pseudomonas aeruginosa,Staphylococcus aureus and Acinetobacter baumannii.The contamination rate of condensate water was 5.0%at 4 hours,37.5%at 8 hours,60.0%at 12 hours,76.7%at 16 hours,95.0%at 20 hours,and 100.0%at 24 hours,respectively.The bacterial contamination rate in condensate water at different time points was statistically significant(P=0.000).The pollution rate at 4 hours was significantly lower than that at 8 hours(P=0.000).Gram-negative bacteria accounted for 57.5%and Gram-positive bacteria accounted for 42.5%.The most common isolates were Staphylococcus aureus,Pseudomonas aeruginosa and Acinetobacter baumannii.The consistency of bacteria in lower respiratory tract and condensate water was 83.3%in severe pneumonia patients undergoing mechanical ventilation.The overall resistance of Pseudomonas a

关 键 词：机械通气 重症肺炎 冷凝水 细菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]