小儿呼吸机相关肺炎的危险因素研究  

Ventilator-associated Pneumonia in Pediatrics: An Analysis of Risk Factors and Microbial Causes

作　　者：严纯雪[1] 贾玉双[1] 黄建芬[1] 张楚南[1] 潘国权[1] 

机构地区：[1]温州医学院育英儿童监护病房,浙江温州325003

出　　处：《中华医院感染学杂志》2002年第11期801-803,共3页Chinese Journal of Nosocomiology

摘　　要：目的　探讨小儿呼吸机相关肺炎 (VAP)的危险因素及病原菌。方法　选取机械通气时间在 >48h30 1例患儿 ,符合 VAP诊断标准 10 8例作为 VAP感染组 ,VAP未感染组作为对照组 ,采用单因素分析 VAP的危险因素 ;并对 VAP作病原菌分析。结果　 VAP发生率为 35 .88%,其中新生儿 40 .5 0 %,儿童 2 8.90 %;单因素分析表明新生儿 ,机械通气时间 >5 d,儿童危重病例评分≤ 90分 ,肺部原有疾病、有胃内容物吸入、鼻饲、使用胃酸抑制剂 /抗酸剂是 VAP的危险因素 ,而机械通气时患儿头部位置抬高 >30°及大剂量静脉注射丙种球蛋白能预防VAP的发生 ;预防性使用抗生素不能降低 VAP的发生 ;病原学以 G- 菌为主 ;前 5位依次为铜绿假单胞菌、肠杆菌属、不动杆菌属、克雷伯菌属和金黄色葡萄球菌。结论　避免 VAP的危险因素 ,使用大剂量静脉注射丙种球蛋白能降低 VAP的发生率。OBJECTIVE To investigate the risk factors and microbial causes related to the development of ventilator-associated pneumonia(VAP). METHODS A total of 301 cases required mechanical ventilation for longer than 24 hours from the Yuyin Pediatrics Hospital Affiliated to Wenzhou Medical College were studied. Comparison between groups of VAP and non VAP was made by unifactor analysis. Microbial causes were analyzed with VAP. RESULTS The incidence rate of VAP was 35.88%, for children 28.90%, for newborn 40.50%. For newborn, ventilation days (<5 days), pediatric critical illness score≤90, primary pulmonary diseases, enteral feeding, H 2 receptor antagonist and antacids were independent factors with VAP. Elevating the head of the bed and intravenous immunoglobulin were useful in prevention of VAP, prophylactic use of antimicrobials can not decrease the morbidity of VAP. The most frequently isolated organisms were Pseudomonas aeruginosa, Enterobacteriaceae, Acinetobacter species, Klebsiella species, Staphylococcus aureus. CONCLUSIONS The results suggest that to avoid risk factors be the effective measure in lowering the incidence rate of VAP. Intravenous immunoglobulins may be useful in both prevention and treatment of VAP.

关 键 词：儿童 呼吸机相关肺炎 危险因素 病原菌 机械通气 VAP 

分 类 号：R725.631[医药卫生—儿科]