地区医院ICU呼吸机相关肺炎及死亡高危因素及病原菌分析

发布时间：2018-03-01 16:54

本文关键词： 重症监护病房(ICU) 住院死亡率院内感染危险因子　出处：《中国现代医学杂志》2014年18期 　论文类型：期刊论文

【摘要】：目的研究湖南怀化市第一人民医院ICU呼吸机相关肺炎(VAP)、死亡高危因素及病原菌检测,为制定这些患者的治疗计划提供依据。方法统计该院2009年6月~2013年3月ICU使用机械通气治疗328例患者的临床资料。筛选出VAP及死亡易感因素,并检验其相关性。结果接受机械通气的328例患者中有49例VAP,其中死亡22例,死亡率为44.9%,明显高于非VAP患者28.7%的死亡率。充血性心力衰竭、糖皮质激素治疗、Pao2/Fio2、APACHE II评分、急性肾功能衰竭及菌血症与VAP发生具有相关性。高龄、高APACHE II评分、低Pao2/Fio2比,易患菌血症,免疫抑制状态,急性肾衰及充血性心力衰竭等原因与死亡相关。多因素分析显示,鼻胃管留置(95%CI,1.78~4.66)、气管切开(95%CI,3.91~11.50)及抑酸剂(95%CI,1.19~6.64)是发生VAP的独立危险因素(均P0.01)。绿脓杆菌和鲍氏不动杆菌是所有VAP感染患者呼吸道分离培养最常见的革兰阴性菌,金黄色葡萄球菌是所有VAP感染患者呼吸道分离培养最常见的革兰阳性菌。在VAP死亡患者中,感染金葡菌及曲霉菌更常见,与存活者相比,差异有显著性。结论 ICU医生应了解呼吸机相关肺炎(VAP)及死亡患者这些危险因素,将有利于这类患者治疗计划的制定。
[Abstract]:Objective to study the risk factors of death and the detection of pathogenic bacteria in ICU ventilator-associated pneumonia in the first people's Hospital of Huaihua City, Hunan Province. Methods the clinical data of ICU patients treated with mechanical ventilation from June 2009 to March 2013 were statistically analyzed. VAP and risk factors for death were screened out. Results there were 49 patients who received mechanical ventilation, 22 of them died, the mortality rate was 44.9, which was significantly higher than the death rate of 28.7% in non-patients with VAP, congestive heart failure, glucocorticoid therapy and Pao2 / Fio2Fio2 Apache II score. Age, high APACHE II score, low Pao2/Fio2 ratio, susceptibility to bacteremia, immunosuppressive state, acute renal failure and congestive heart failure were associated with death. The nasogastric tube indwelling (95CII 1.784.66), tracheotomy 95 CI3.91 (11.50) and acid suppressant 1.196.64) were independent risk factors for the occurrence of VAP (all P 0.01). Pseudomonas aeruginosa and Acinetobacter baumannii were the most common Gram-negative bacteria isolated and cultured in the respiratory tract of all patients with VAP infection. Staphylococcus aureus is the most common gram-positive bacteria isolated from the respiratory tract of all patients with VAP infection. Staphylococcus aureus and aspergillus infection are more common in VAP dead patients than in survivors. Conclusion Dr ICU should understand the risk factors of ventilator associated pneumonia (VAP) and death patients, which will be helpful to the formulation of treatment plan for these patients.
【作者单位】：湖南怀化市第一人民医院重症医学科;
【分类号】：R563.1

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