摘要
目的:探讨新生儿呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)的危险因素、病原菌、耐药性及预防措施。方法:回顾分析2008年1月-2010年1月我院新生儿重症监护室(Neonatal intensive care unit,NICU)中使用呼吸机机械通气127例危重新生儿临床资料。其中43例发生VAP。利用统计分析VAP发生与患儿胎龄、出身体重、基础疾病关系。收集深部痰液样本分离病原菌并进行耐药分析。结果:胎龄(<28周)、低出生体重(<2 000 g)、感染性基础疾病为VAP发生的危险因素,不同时间VAP患儿的发生率及死亡率差别有统计学意义(P<0.005)。分离培养病原菌发现主要病原菌为革兰阴性杆菌,占80.3%,其中以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌最多见,且多为耐药菌。结论:NICU中VAP发生与患儿胎龄、体重及基础疾病密切相关,其病原菌以革兰阴性杆菌为主,对美罗培南、亚胺培南最为敏感,治疗中应根据细菌培养结果正确合理选择抗生素,提高机械通气的效率。
Objective：To investigate the morbidity,risk factor,etiology characteristics,and drug resistance spectrum of ventilatorassociated pneumonia（VAP） and provide reasonable ways for VAP prevention.Methods：A retrospective study was conducted in 127 neonatal intensive care unit（NICU） patients admitted to the Children＇s Hospital of Chongqing Medical University from January 2008 to January 2010.43 patients developed VAP.Statistical analysis was carried out to investigate the correlation between VAP incidence and gestational age,birth weight and primary disease.The sputum samples were used for drug resistance analysis.Results：Statistical analysis showed that gestational age,low birth weight,and primary infection disease were risk factors associated with the development of VAP.The morbidity and mortality of VAP at different time points had statistically significant difference（P〈0.005）.The proportion of gram negative bacilli was the highest（80.3%）.The most common gram-negative organisms were klebsiella pneumoniae,pseudomonas aeruginosa,escherichia coli and the drug resistance was high in NICU.Conclusion：VAP is related to gestational age,birth weight and primary disease.The most common causative bacteria of VAP are gram-negative organisms,which are highly sensitive to meropenem,imipenem.It is reasonable to choose antibiotic based on the bacterium identified so as to improve the efficiency of mechanical ventilation.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2011年第9期1107-1110,共4页
Journal of Chongqing Medical University
关键词
新生儿
呼吸机相关肺炎
危险因素
耐药性
neonate
ventilator associated pneumonia
risk factor
drug resistance
