非发酵革兰阴性杆菌感染对食管癌术后并发肺部感染需机械通气患者的影响

摘要

Objective To observe the nonfermenting gram-negative bacilli (NFGNB)influencing mechanical ventilation in patients with pneumonia after esophagectomy. Methods Required endotracheal intubation or tracheostomy and mechanical ventilation were applied in 61 patients, of which 32 cases had NFGNB infection, 29 cases did not have NFGNB. The differences of mechanical ventilation time, ICU time, length of stay (LOS), ventilatorassociated pneumonia, tracheostomy in two groups were analyzed. Results Ventilator-associated pneumonia incidence[63.0% (20 cases)vs 21% (6 cases) ,P ＜0.01] and tracheotomy rate [53% (17 cases)vs 28% (8 cases) ,P ＜0. 05] increased in NFGNB group. During mechanical ventilation, ICU time and LOS in NFGNB patients were significantly longer than those without NFGNB [( 14 ± 10) d vs ( 7 ± 5 ) d, (9 ± 4 ) d vs ( 17 ± 15 ) d, ( 32 ± 15 ) vs (43 ± 22)d,P ＜0.05]. Logistic regression analysis showed that the double NFGNB infection were independent factors causing prolonged mechanical ventilation (P＜0. 05), OR was 6.353 (95% CI 1.203-33.549). Conclusions NFGNB postoperative infection leads to extension of mechanical ventilation time, ICU time and LOS, increased ventilator-associated pneumonia and tracheostomy rates. Particularly, double NFGNB infection causes significantly prolong the time of mechanical ventilation. Intensive prevention of postoperative pneumonia, especially NFGNB infection has important clinical significance.%目的 观察非发酵革兰阴性杆菌(NFGNB)对食管癌切除术后并发肺部感染需机械通气患者的影响.方法 将61例行食管癌切除术后并发肺部感染需机械通气患者,按是否检出NFGNB,分为NFGNB感染组(32例)和无NFGNB感染组(29例).回顾性分析和比较2组患者机械通气时间、住ICU时间、住院时间、呼吸机相关性肺炎发生率、气管切开率和病死率.结果 NFGNB感染患者呼吸机相关性肺炎的发生率[63.0%(20例)比21%(6例),P＜0.01]和气管切开率[53%(17例)比28%(8例),P＜0.05]均明显高于无NFGNB感染患者,机械通气时间、住ICU时间、住院时间明显长于NFGNB感染患者[(14±10)d比(7±5)d,(9±4)d比(17±15)d,(32±15)d比(43±22)d,P＜0.05].二重NFGNB感染是机械通气时间延长的独立影响因素(P＜0.05),OR为6.353(95%CI1.20～33.5).结论 NFGNB可延长食管癌术后并发肺部感染需机械通气患者机械通气时间、住ICU时间和住院时间,增加患者呼吸机相关性肺炎的发生率和气管切开率,特别是二重NFGNB感染可明显延长机械通气时间.因此积极预防术后肺部感染特别是NFGNB感染的发生有重要的临床意义.