呼吸机相关性肺炎30例临床分析

张京利　王力红　王桂珍
　　【摘要】　目的　了解呼吸机相关性肺炎(VAP)的危险因素、病原菌种类、治疗及预后。方法　对我院30例VAP患者进行回顾性调查分析。结果　原发病以急性重症胰腺炎居多。VAP发生前已有其他部位感染者占33.3%，已有损伤和/或手术者占46.6%。VAP发生前76.7%的病例使用了制酸剂，的病例使用了抗菌药物。VAP病原菌中G-杆菌占84.2%，铜绿假单胞菌占G-杆菌的50%。选用频率较高的三种抗菌药物是三代头孢菌素、伊米配能、青霉素类。该组病例死亡率为33.3%。结论　重症感染、使用抗菌药物和制酸剂、手术和损伤是VAP发生的易感因素。VAP病原菌主要为G－杆菌，尤以铜绿假单胞菌为多。 　　

【关键词】　肺炎　　呼吸机　　医院感染　　铜绿假单胞菌

Clinical analysis of ventilator-associated pneumonia in 30 cases

Zhang Jingli Wang Lihong,Wang Guizhen
(Xuan Wu Hospital,Capital University of the Medical Sciences,Beijing 100053)

【Abstract】　ob[x]jective　To identify the risk factors,pathogens,treatment and prognosis in patients with ventilator-associated pneumonia (VAP).Methods　A retrospective investigation of 30 VAP patients was done.Results　The primary disease was mostly severe acute pancreatitis.Before VAP,extra-pulmonary infections occurred in 33.3% of cases,trauma/operations in 46.6%.Before VAP,76.7% of patients received antacids and patients had antibiotics.Gramnegative bacilli accounted for 84.2% of the pathogens of VAP,among which pseudomonas aeruginosa amounted to 50%.The three most often used antibiotics were the third generation cephalosporins,imipenem and penicillins.The mortality rate in this group was 33.3%.Mortality directly or indirectly related to VAP was 80%.Conclusions　Severe infections,use of antibiotics and antacids,trauma and operations predisposed patients to VAP.The chief pathogens of VAP were Gram-negative bacilli,especially P aeruginosa.
　　【Key words】　Pneumonia　　Ventilator　　Nosocomial infection　　P aeruginosa

　　机械通气疗法在治疗危重病人方面具有重要的临床价值，但由此而引发的呼吸机相关性肺炎(VAP)却给原发病的治疗带来更大的困难，可导致患者的治疗方案更加复杂化，并提高了患者的死亡率［1，2］。因此，VAP已成为呼吸机通气管路等，树立“待气管如血管”的观念，以减少外源性感染的机会。
张京利(首都医科大学宣武医院邮政编码 100053)
王力红(首都医科大学宣武医院邮政编码 100053)
王桂珍(首都医科大学宣武医院邮政编码 100053)

参　考　文　献
1.Estes RJ,Meduri GU.The pathogenesis of ventilator-associated pneumonia:I mechanisms of bacterial transcolonization and airway intensive.Intensive Care MED,1995,21:365.
2.Griffin JJ,Meduri GU.New approaches in the giagnosis of nosocomial pneumonia.Med Clin North AM,1994,78:1091.
3.徐秀华.临床医院感染学.长沙：湖南科学技术出版社.1998：27～30.
4.陈　鸣，府伟灵，陈依赐.呼吸机相关肺炎的流行病学分析.中华医院感染学杂志，1998，8：212.