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目的探讨新生儿呼吸机相关性肺炎(VAP)的高危因素、病原学特点及耐药性。方法选择2008年1月-2015年12月来宾市人民医院新生儿科住院治疗的VAP新生儿100例为VAP组和未发生VAP新生儿100例作为对照组,取下呼吸道分泌物进行细菌培养和药敏试验。结果 VAP组新生儿出生体质量、入院时孕周低于对照组(P<0.05),VAP组呼吸机应用时间、急性生理与慢性健康评分(APACHEⅡ)、入院时日龄和上机时间高于对照组(P<0.05),VAP组白蛋白水平低于对照组(P<0.05),VAP组早产儿、胃内容物反流、应用抗酸剂、应用鼻胃管、插管次数≥2次的发生率均高于对照组(P<0.05),VAP组1 min Apgar评分>7分的比例低于对照组(P<0.05)。呼吸机应用时间长、早产儿、白蛋白水平低、1 min Apgar评分低、插管次数多是VAP的独立高危因素(P<0.05)。VAP组新生儿中,共培养出病原菌89株,革兰阳性菌9株(10.1%),均为金黄色葡萄球菌(10.1%);革兰阴性菌为76株(85.4%),主要为肺炎克雷伯杆菌(24.7%)和大肠埃希菌(20.2%);真菌4株(4.5%),均为白假丝酵母菌(4.5%)。金黄色葡萄球菌对氨苄西林、哌拉西林、阿莫西林、头孢哌酮和红霉素均100%耐药,肺炎克雷伯杆菌对氨苄西林100%耐药,大肠埃希菌对氨苄西林100%耐药,铜绿假单胞菌对氨苄西林、头孢曲松钠100%耐药。结论减少呼吸机应用时间、预防早产儿的发生、提高白蛋白水平、改善胎儿宫内缺氧情况提高出生1 min Apgar评分、减少插管次数对降低新生儿VAP的发生有积极意义。
Objective To investigate the risk factors, etiological characteristics and drug resistance of neonatal ventilator-associated pneumonia (VAP). Methods From January 2008 to December 2015, 100 neonates with VAP who were hospitalized in neonatal department of Laibin Municipal People’s Hospital were treated with VAP group and 100 without VAP neonates as control group. Respiratory secretions were removed for bacterial culture and drug treatment Sensitive test. Results The neonatal birth weight of the VAP group was lower than that of the control group at admission (P <0.05). The duration of ventilator application, acute physiology and chronic health score (APACHEⅡ) (P <0.05). The level of albumin in VAP group was lower than that in control group (P <0.05). In VAP group, (P <0.05). The rate of Apgar score> 7 at 1 min in VAP group was lower than that in control group (P <0.05). Ventilator used for a long time, premature children, low albumin level, 1 min Apgar score low, the number of intubation more independent risk factors for VAP (P <0.05). There were 89 pathogenic bacteria and 9 gram-positive bacteria (10.1%) in the neonatal VAP group, all of which were Staphylococcus aureus (10.1%). Gram-negative bacteria were 76 (85.4%), mainly pneumonia Klebsiella (24.7%) and Escherichia coli (20.2%); 4 fungi (4.5%) were Candida albicans (4.5%). Staphylococcus aureus to ampicillin, piperacillin, amoxicillin, cefoperazone and erythromycin 100% were resistant to Klebsiella pneumoniae 100% resistant to ampicillin, Escherichia coli ampicillin 100 % Resistant, Pseudomonas aeruginosa to ampicillin, ceftriaxone 100% resistant. Conclusions Reducing the application time of ventilator, preventing the occurrence of premature infants, raising the level of albumin and improving the hypoxia in the fetus raise Apgar score at 1 min, and reducing the number of intubation has a positive effect on reducing the incidence of VAP in neonates.