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目的:调查北仑区人民医院重症监护室(ICU)呼吸机相关肺炎(VAP)患者的一般情况,分析病原菌及耐药性,并提出针对性的防治措施。方法:按照严格的诊断标准,收集2012~2013年间北仑区人民医院ICU中VAP的病例,无年龄和性别限制,获得患者以及家属的知情同意。对其一般情进行描述,对可能的危险因素进行单因素分析探讨,描述分离出的患者病原菌分布情况和药敏试验的分布情况。结果:156例重症监护病房接受呼吸机通气的患者,发生VAP者60例,VAP发生率为38.5%。其中男性33例,女性27例。年龄大于等于60岁、机械通气时间超过5天、服用抑酸剂、留置胃管为危险因素。60例VAP患者共分离出病原菌111株,以革兰阴性菌为主(66.7%),其次是革兰阳性菌(19.8%)和真菌(13.5%);最常见致病菌依次为鲍曼不动杆菌(28株)、铜绿假单胞菌(21株)、肺炎克雷伯菌(12株),存在一定的耐药情况。结论:ICU应严格无菌操作和隔离制度,减少交叉感染,适当减少肌松剂、镇静剂及抑酸剂的使用;缩短机械通气时间,争取早期拔管或序贯应用无创通气,减少胃管的留置时间等方法以增加患者免疫功能,同时根据药敏试验合理选用抗生素降低VAP发生。
Objective: To investigate the general situation of patients with ventilator - associated pneumonia (VAP) in intensive care unit (ICU) of Beilun District People ’s Hospital, analyze pathogens and drug resistance, and put forward targeted prevention and treatment measures. Methods: According to the strict diagnostic criteria, the cases of VAP in ICU of Beilun District People’s Hospital from 2012 to 2013 were collected. There was no age and sex restriction, and the informed consent of patients and their families was obtained. Describe the general situation, univariate analysis of possible risk factors, describe the distribution of pathogenic bacteria isolated and the distribution of drug susceptibility test. Results: In 156 ICU patients receiving ventilator ventilation, 60 patients developed VAP and the VAP incidence was 38.5%. There were 33 males and 27 females. Age 60 years or older, mechanical ventilation more than 5 days, taking acid inhibitors, indwelling gastric tube as a risk factor. A total of 111 pathogenic bacteria were isolated from 60 VAP patients, mainly Gram-negative bacteria (66.7%), followed by Gram-positive bacteria (19.8%) and fungi (13.5%). The most common pathogens were Bowman’s Acinetobacter (28 strains), Pseudomonas aeruginosa (21 strains), Klebsiella pneumoniae (12 strains), there is a certain resistance. Conclusion: ICU should be strictly aseptic and isolation system to reduce cross-infection, the appropriate reduction of muscle relaxants, sedatives and acid-suppressing agents; shorten the duration of mechanical ventilation for early extubation or sequential application of noninvasive ventilation, reduce gastric tube Indwelling time and other methods to increase the patient’s immune function, while rational use of antibiotics in susceptibility testing to reduce the occurrence of VAP.