慢性阻塞性肺疾病急性加重期318例的呼吸机相关性肺炎预测指标和微生物学特征分析  

Predictors and microbiological characteristics of ventilator-associated pneumonia in patients with chronic obstructive pulmonary disease

作　　者：吕培瑾[1] 李书阅[1] 蒋云书 董亮亮[1] LYU Peijin;LI Shuyue;JIANG Yunshu;DONG Liangliang(Department of Respiratory Medicine,Liaocheng Second People's Hospital,Liaocheng,Shandong 252600,China)

机构地区：[1]聊城市第二人民医院呼吸内科,山东聊城252600

出　　处：《安徽医药》2022年第4期770-773,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨慢性阻塞性肺疾病(COPD)急性加重期呼吸机相关性肺炎(VAP)的预测指标和微生物学特征。方法 以2016年12月至2019年12月聊城市第二人民医院呼吸内科收治的COPD急性加重期318例为研究对象,根据是否发生VAP分为VAP组和非VAP组。记录病人基线人口统计学信息及临床特征。采用多因素logistic回归分析COPD急性加重期VAP的预测因素。通过革兰染色涂片及镜检,并对标本进行培养及药敏试验来进行微生物学诊断。结果 COPD持续时间、住院前恶化持续时间、APACHE-2评分、入院时SOFA评分VAP病人分别为10.38(8.50,12.27)年、(8.65±2.69)d、(21.24±2.57)分、(7.55±2.33)分,非VAP病人分别为3.90(2.40,8.40)年、(5.22±2.16)d、(16.26±2.46)分、(4.34±1.50)分,两组相比差异有统计学意义(P<0.01)。与非VAP病人比较,VAP病人因COPD多次住院、肺结核病史、糖尿病、入院后再次插管、入院时使用血管加压药、过去90 d使用抗生素比例显著升高(P<0.05)。多因素logistic回归分析结果示,因COPD多次住院、糖尿病、APACHE-2评分、入院时SOFA评分、入院后再次插管、过去90 d使用抗生素是COPD急性加重期VAP发生的重要预测因素(OR值分别为:67.128、12.996、2.352、2.054、7.253、3.546)。57(100%)例VAP病人支气管肺泡灌洗(BAL)或气管内抽吸(ETA)标本中均存在革兰阴性杆菌。其中鲍曼不动杆菌是最常见的微生物(27例,47.3%),其次是肺炎克雷伯菌(18例,31.6%),铜绿假单胞菌(3例,5.3%)和肠杆菌属(3例,5.3%)。所有病原体均具有多重耐药性。结论 因COPD多次住院、糖尿病、APACHE-2评分、入院时SOFA评分、入院后再次插管、过去90 d使用抗生素是COPD急性加重期VAP发生的独立预测因子。VAP的抗菌治疗应覆盖具有多重耐药性的革兰阴性杆菌。Objective To investigate the predictors and microbiological characteristics of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 318 patients with exacerbation of COPD who were admitted to the Department of Respiratory Medicine,Liaocheng Second People’s Hospital from December 2016 to December 2019 were selected as the research subjects.They were assigned into VAP group and non-VAP group according to whether VAP occurred.Baseline demographic information and clinical characteristics of patients were recorded.Multivariate Logistic regression was used to analyze the predictors of VAP in patients with COPD exacerbation.Microbiology diagnosis was performed by Gram stain smear and microscopy,and culture and drug sensitivity tests were performed on the specimens.Results The duration of COPD,the duration of deterioration before hospitalization,apache-2 score,SOFA score at admission,VAP patients were 10.38 (8.50,12.27) years,(8.65±2.69) days,(21.24±2.57)points and (7.55±2.33) points respectively,and non VAP patients were 3.90 (2.40,8.40) years,(5.22±2.16) days,(16.26±2.46) points and (4.34±1.50) points respectively.There was significant difference between the two groups (P<0.01).Compared with non-VAP patients,the proportion of multiple hospitalizations due to COPD,history of tuberculosis,diabetes,re-intubation after admission,use of vasopressors during admission,antibiotics used in the past 90 days in VAP patients were increased significantly (P<0.05).Multivariate Logistic regression analysis showed multiple hospitalizations due to COPD,diabetes,APACHE-2 score,SOFA score at admission,reintubation after admission,and antibiotic use in the past 90 days were important predictors of VAP in patients with COPD exacerbation (OR values were 67.128,12.996,2.352,2.054,7.253 and 3.546 respectively).Gram-negative bacteria were present in 57 (100%) VAP patients with bronchoalveolar lavage (BAL) or intratracheal aspiration (ETA) specimens.Acinetobacter baumanni

关 键 词：肺疾病 慢性阻塞性 肺炎 呼吸机相关性 鲍氏不动杆菌 肺炎克雷伯菌 预测因子 

分 类 号：R563.9[医药卫生—呼吸系统]