呼吸机相关性肺炎患者感染病原菌分布及炎症反应指标的临床评价

发布时间：2018-03-17 06:11

本文选题：呼吸机相关性肺炎　切入点：病原菌　出处：《中华医院感染学杂志》2017年22期 　论文类型：期刊论文

【摘要】：目的分析呼吸机相关性肺炎(VAP)患者感染病原菌分布及炎症反应指标检测的临床价值。方法选择2015年12月-2017年2月医院收治的机械通气治疗患者120例,其中,呼吸机相关性肺炎患者75例为甲组,未感染者45例为乙组,同期健康体检者50例为对照组,检测VAP患者感染病原菌分布,比较三组患者血清C-反应蛋白(CRP)、降钙素原(PCT)及炎性因子水平。结果 75例甲组患者共检出病原菌92株,以革兰阴性菌为主,共分离53株占57.61%,其中肺炎克雷伯菌18株占19.57%;革兰阳性菌33株,占35.87%,金黄色葡萄球菌占比最高为17株占18.48%;肺炎克雷伯菌、大肠埃希菌与铜绿假单胞菌对亚胺培南的敏感性较高;金黄色葡萄球菌、表皮葡萄球菌对万古霉素与替考拉宁有较高的敏感性;甲组患者PCT、CRP、白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平高于乙组与对照组,差异有统计学意义(P0.05)。结论呼吸机相关性肺炎患者病原菌以肺炎克雷伯菌及铜绿假单胞菌为主,该病原菌对广谱抗菌药物耐药情况有加强的趋势;血清CRP、PCT及炎性因子检测对VAP具有重要的诊断价值。
[Abstract]:Objective to analyze the clinical value of pathogenic bacteria distribution and inflammatory response index in patients with ventilator-associated pneumonia (VAP). Methods 120 patients treated with mechanical ventilation from December 2015 to February 2017 were selected. 75 patients with ventilator-associated pneumonia were treated as group A, 45 patients without infection as group B and 50 healthy persons as control group. The distribution of pathogenic bacteria in patients with VAP was detected. The levels of serum C-reactive protein (CRP), procalcitonin (PCT) and inflammatory cytokines were compared among the three groups. Results 92 strains of pathogenic bacteria were detected in 75 patients in group A. Gram-negative bacteria were the main pathogens. 53 strains were isolated, including 18 strains of Klebsiella pneumoniae (19.57%), 33 strains of Gram-positive bacteria (35.87%), 17 strains of Staphylococcus aureus (18.48%), Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa with high sensitivity to imipenem. Staphylococcus aureus and Staphylococcus epidermidis had high sensitivity to vancomycin and teicoplanin. Conclusion Klebsiella pneumoniae and Pseudomonas aeruginosa are the main pathogens in patients with ventilator-associated pneumonia. The detection of serum CRPP-PCT and inflammatory factors has important diagnostic value for VAP.
【作者单位】：遵义市第一人民医院急诊科;遵义市第一人民医院护理部;
【分类号】：R446.5;R563.1

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