慢性阻塞性肺疾病患者呼吸机相关性肺炎的病原菌分布与临床分析  

Clinical Characteristics and Pathogen Distribution in COPD Patients with Ventilator-associated Pneumonia

作　　者：曾惠清[1] 彭丽红[1] 蔡雪莹[1] 陈波[1] 林秀丽[1] 张孝斌[1] 姚艺辉 

机构地区：[1]厦门大学附属中山医院福建医科大学教学医院呼吸科,福建厦门361004 [2]厦门市临床检验中心,福建厦门361004

出　　处：《中国呼吸与危重监护杂志》2015年第2期135-138,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨慢性阻塞性肺疾病(简称慢阻肺)患者呼吸机相关性肺炎(VAP)的病原菌分布与临床特点。方法回顾分析厦门大学附属中山医院呼吸科及重症加强治疗病房2007年11月至2013年10月收治的慢阻肺并呼吸衰竭行气管插管机械通气发生VAP的92例患者,收集下呼吸道分泌物、肺泡灌洗液细菌培养和药敏试验结果,并分析其临床特点。结果慢阻肺并VAP患者中分离出的菌株中以革兰阴性杆菌为主,主要病原菌依次为鲍曼不动杆菌(24.1%)、铜绿假单胞菌(17.6%)、肺炎克雷伯菌(15.9%)、耐甲氧西林金黄色葡萄球菌(14.7%)和大肠埃希菌(10.6%)。与呼吸机使用前应用过抗菌药物治疗者比较,未应用抗菌药物治疗者病死率明显较低(17.9%比40.6%,P<0.01)。而应用降阶梯治疗的患者病死率明显低于升阶梯治疗者(19.3%比57.1%,P<0.01)。呼吸机使用超过4 d发生VAP的病死率为54.8%,呼吸机使用4 d内发生VAP的病死率为45.2%,两者间差异无统计学意义(P>0.05)。结论慢阻肺并VAP患者的病原菌对常见抗菌药物耐药性较高,机械通气前抗菌药物应用者的VAP病原菌高度耐药,病死率较高;抗菌药物治疗应用降阶梯疗法病死率较低;迟发性VAP与早发性VAP的病死率无明显差异。Objective To analyze the clinical characteristics and pathogenesis in patients with chronic obstructive pulmonary disease( COPD) with ventilator-associated pneumonia( VAP). Methods Ninety-two patients with VAP who underwent mechanical ventilation via tracheal incubation due to COPD and respiratory failure were recruited in the study. The clinical characteristics,bacterial culture and antibiotics sensitivity of specimen from tracheal secretion and bronchoalveolar lavage fluid were retrospectively analyzed.Results The main pathogenic bacteria in the patients with COPD with VAP were as following,ie.Ainetobacter baumanii( 24. 1%),Pseudomonas aeruginosa( 17. 6%),Klebsiella spp( 15. 9%),Methicillinresistant Staphylococcus aureus( 14. 7%),and Escherichia coli( 10. 6%) in which Gram negative bacteria were predominant. When compared with the patients who received antibiotics before mechanical ventilation,the mortality in the patients who did not receive antibiotics before mechanical ventilation was significantly lower( 17. 9% vs. 40. 6%,P < 0. 01). The patients who received de-escalation antibiotics therapy had lower mortality than those who received escalation antibiotics therapy( 19. 3% vs. 57. 1%,P < 0. 01). There was no significant difference in mortality between the patients who suffered from VAP less or more than 4days after mechanical ventilation( 54. 8% vs. 45. 2%,P > 0. 05). Conclusions High drug resistant rate is observed in patients with COPD and VAP especially in those patients who using antibiotic before mechanical ventilation. De-escalation antibiotics therapy can lower the mortality. The mortality rate is not significant different between early-onset and late-onset VAP in patients with COPD.

关 键 词：慢性阻塞性肺疾病 呼吸机相关性肺炎 病原菌 临床特征 

分 类 号：R563.9[医药卫生—呼吸系统]