机械通气中心静脉导管感染患者肺功能及病原学特点研究

发布时间：2018-04-01 03:32

本文选题：机械通气　切入点：中心静脉导管　出处：《中华医院感染学杂志》2017年20期

【摘要】：目的探究行机械通气中心静脉导管发生中心静脉导管相关性血流感染(CRBSI)患者的肺功能及病原菌分布和耐药性。方法选取2012年8月-2016年12月于医院接受治疗的52例行机械通气留置中心静脉导管发生CRBSI患者列为感染组,同时选取同时期在医院治疗的58例相同未发生CRBSI患者列为未感染组。分析感染组患者感染的病原菌分布及主要菌群对常用抗菌药物的药敏结果,对比两组患者肺功能的相关指标。结果感染组52例患者共分离病原菌60株,其中革兰阳性菌39株占65.00%,以表皮葡萄球菌及金黄色葡萄球菌为主,革兰阴性菌21株占35.00%,以肺炎克雷伯菌及大肠埃希菌为主。药敏结果显示,革兰阳性菌对青霉素、庆大霉素、阿奇霉素等的耐药率较高,最高为100.00%,对万古霉素较敏感;革兰阴性菌对阿莫西林、妥布霉素及庆大霉素等耐药率较高,最高为100.00%,对亚胺培南较敏感。感染组患者肺功能指标肺活量(FVC)、第1秒呼气容积(FEV1)及FEV1/FVC分别为(1.99±0.28)L、(3.19±0.21)L、(49.12±6.54)%显著低于未感染组(2.36±0.31)L、(3.45±0.63)L、(54.21±6.89)%(P0.05)。结论 CRBSI会导致行机械通气中心静脉导管患者肺功能下降,建议采用严格遵守无菌操作原则等防治措施,早期降低患者感染风险。
[Abstract]:Objective to investigate the pulmonary function, pathogenic bacteria distribution and drug resistance in patients undergoing mechanical ventilation with central venous catheter associated blood stream infection (CRBSII). Methods 52 patients treated in hospital from August 2012 to December 2016 were selected. Patients with CRBSI caused by mechanical ventilation indwelling central venous catheter were classified as infection group. At the same time, 58 patients with the same CRBSI who were treated in hospital at the same time were selected as the uninfected group. The distribution of pathogenic bacteria and the susceptibility of the main bacteria to common antimicrobial agents in the infected group were analyzed. Results 60 strains of pathogenic bacteria were isolated from 52 patients in the infection group, of which 39 strains were Gram-positive bacteria, mainly Staphylococcus epidermidis and Staphylococcus aureus. There were 21 Gram-negative strains (35.00%), mainly Klebsiella pneumoniae and Escherichia coli. The drug sensitivity of Gram-positive bacteria to penicillin, gentamicin and azithromycin was higher, the highest was 100.00,sensitive to vancomycin. Gram-negative bacteria have higher resistance to amoxicillin, tobramycin and gentamicin. The highest value was 100.00g, which was more sensitive to imipenem. The vital capacity of lung function in the infected group was 1.99 卤0.28 L (FEV1) and FEV1/FVC was 1.99 卤0.28, respectively, which was significantly lower than that in the uninfected group (49.12 卤6.54 卤2.36 卤0.31). Conclusion CRBSI can induce the decrease of pulmonary function in the patients with mechanical ventilation central venous catheter, and the lung function of the infected patients is significantly lower than that of the uninfected group (P < 0.01). Conclusion the lung function of the patients undergoing mechanical ventilation with central venous catheter is significantly lower than that of the uninfected group (2.36 卤0.31). Conclusion the lung function of the patients undergoing mechanical ventilation with central venous catheter is significantly lower than that of the uninfected group (P < 0.05). It is suggested that strict adherence to the principle of aseptic operation and other preventive measures should be adopted to reduce the risk of infection in patients at an early stage.
【作者单位】：南阳医学高等专科学校第一附属医院重症医学科;
【基金】：河南省科技厅计划基金资助项目(122300410330)
【分类号】：R459.7

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