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目的探讨严重创伤后急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者呼吸机相关性肺炎(VAP)的发病率和病原菌分布以及药敏试验特点,并对VAP影响因素进行分析。方法对医院综合ICU和急诊ICU于2004年1月-2008年3月收治的严重创伤致ALI/ARDS行机械通气>48 h的183例患者临床资料进行分析。结果183例患者并发VAP有98例,发病率为53.6%,其中早发性VAP有42例,晚发性VAP 56例,98例患者共检出病原菌276株,主要是铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌,57例检出≥2种病原菌,41例单检出1种病原菌,患者昏迷、呼吸机治疗时间、有创通气、应用制酸剂、应用≥2种抗菌药物、低血清白蛋白等因素与感染发生有显著相关性。结论ALI患者VAP发病率高,细菌耐药普遍,混合感染多见。
Objective To investigate the incidence and pathogenic bacteria distribution of ventilator-associated pneumonia (VAP) in patients with severe traumatic acute lung injury / acute respiratory distress syndrome (ALI / ARDS) and the characteristics of drug susceptibility test. The influencing factors of VAP were analyzed. Methods The clinical data of 183 patients with severe traumatic ALI / ARDS with mechanical ventilation> 48 h after ICU and emergency ICU in hospital from January 2004 to March 2008 were analyzed. Results 183 patients were complicated with VAP in 98 cases, with an incidence rate of 53.6%. Among them, 42 cases were premature VAP, 56 cases were late VAP, and 276 pathogens were detected in 98 cases, mainly Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, 57 cases were detected ≥2 kinds of pathogens, 41 cases were detected a single pathogen, coma patients, ventilator treatment time, invasive Ventilation, the application of antacids, application of ≥ 2 kinds of antimicrobial agents, low serum albumin and other factors have a significant correlation with the occurrence of infection. Conclusion The incidence of VAP in patients with ALI is high, bacterial resistance is common, and mixed infection is more common.