论文部分内容阅读
目的 探讨胃腔内病原菌定植的影响因素以及胃腔定植菌在机械通气相关性肺炎(VAP)内源性发病机制中的作用。方法 前瞻性队列研究 ,动态观察和比较重症监护病房 (ICU)建立人工气道包括气管插管或气管切开患者 (98例 ,VAP组 5 2例 ,无VAP组 4 6例 )胃腔和口咽部病原菌定植种类、浓度、与采样时间的关系 ,以及发生肺炎后下呼吸道标本中出现病原菌的种类与时序。结果 (1)胃腔内定植菌检出率随胃液pH值升高逐渐增加。胃液pH >4时 ,胃腔内革兰阴性杆菌分离率明显上升 ,VAP组革兰阴性杆菌检出率达 5 2 5 %。胃液pH值与胃内革兰阴性杆菌浓度的对数呈正相关 (r =0 4 87,P =0 0 0 1)。胃液pH >4时的VAP发生率高于pH≤ 4 (P =0 0 17)。 (2 )VAP组肠杆菌科细菌检出率随插管时间延长而增加 ,至插管第 5天达 4 5 2 % ,无VAP组为 11 1% (P <0 0 1)。 (3)肠杆菌科细菌在胃腔和口咽部定植有先后次序 ,胃腔肠杆菌科细菌早于口咽部定植 1～ 2d ,比较肠杆菌科细菌在两部位定植次序差异有显著性 (P =0 0 15 )。 (4) 5 2例VAP患者有 12例下呼吸道病原菌呈现胃腔→口咽部→下呼吸道的逆向定植次序。 3例出现胃腔→下呼吸道的定植次序。结论 (1)胃液pH值是影响胃腔定植菌特别是革兰阴性杆菌定植的主要因素。 (2 )VAP
Objective To investigate the influencing factors of pathogenic bacteria colonization in gastric cavity and the role of gastric cavity colonization bacteria in endogenous pathogenesis of mechanical ventilation-associated pneumonia (VAP). Methods Prospective cohort study, dynamic observation and comparison of intensive care unit (ICU) established artificial airway including endotracheal intubation or tracheotomy (98 cases, 52 cases in VAP group and 46 cases in non-VAP group) Pharyngeal pathogenic bacteria colonization types, concentrations, and sampling time, and the occurrence of pneumonia after the lower respiratory tract specimens in the pathogen species and timing. Results (1) The detection rate of intragastric colonization increased gradually with the increase of gastric pH value. Gastric fluid pH> 4, the gastric cavity Gram-negative bacteria separation rate was significantly increased, VAP group Gram-negative bacilli detection rate of 52.5%. The gastric pH value was positively correlated with the logarithm of Gram-negative bacilli in the stomach (r = 0 477, P = 0 0 01). The incidence of VAP at gastric pH> 4 was higher than that of pH ≤ 4 (P = 0 0 17). (2) The detection rate of Enterobacteriaceae in VAP group increased with intubation time, reaching 452% on the fifth day after intubation and 11.1% (P <0.01) in the non-VAP group. (3) Enterobacteriaceae in the stomach and oropharyngeal colonization has the order, Enterobacteriaceae earlier than oropharyngeal colonization of 1 ~ 2d, Enterobacteriaceae colonization in the order of the order was significant ( P = 0 0 15). (4) Twelve cases of lower respiratory tract pathogen in 52 patients with VAP presented reverse colonization order of the stomach cavity → oropharynx → lower respiratory tract. 3 cases of gastric cavity → lower respiratory tract colonization order. Conclusions (1) The pH value of gastric juice is the main factor affecting colonization of gastric cavity, especially Gram-negative bacilli. (2) VAP