慢性阻塞性肺疾病患者呼吸机相关肺部感染的临床研究

发布时间：2018-06-14 16:49

本文选题：慢性阻塞性肺疾病 + 呼吸机相关肺部感染　；参考：《中华医院感染学杂志》2017年22期

【摘要】：目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。
[Abstract]:Objective to study the pathogenic bacteria distribution and related risk factors of ventilator associated pulmonary infection (VAP) during mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) and to provide reference for clinical treatment of VAP. Methods from January 2012 to January 2016, 128 COPD patients undergoing mechanical ventilation were selected as study subjects. The incidence of mechanical ventilation was observed and the related factors were analyzed by univariate and multivariate logistic regression analysis. At the same time, the patients retained qualified sputum specimens for sputum culture to detect the distribution of pathogenic bacteria. Results the incidence of VAP in 128 patients with COPD was 68.755.The sputum samples of 88 patients with VAP cultured 125 strains of pathogenic bacteria. Among them, 103 Gram-negative bacteria accounted for 82.4%, 3 Gram-positive bacteria accounted for 2.4% and 19 fungi accounted for 15.2% of COPD patients. The independent risk factors for VAP after mechanical ventilation were tracheal intubation and diabetes mellitus. When the duration of mechanical ventilation was more than 3 days, the mortality of VAP patients with smoking history and indwelling gastric tube was 31.8, which was significantly higher than that of non-VAP patients (7.5%). Conclusion the incidence of VAP in COPD patients is high and the risk factors of VAP are many.
【作者单位】：邢台市人民医院呼吸内科;
【基金】：邢台市科技计划基金资助项目(2012ZC174)
【分类号】：R563

【相似文献】