老年早发性与迟发性呼吸机相关性肺炎患者病原菌特征比较

摘要

目的 观察并比较老年重症患者早发性与迟发性呼吸机相关性肺炎的病原菌特征,以期为临床防治提供指导和依据. 方法 回顾性分析276例我院行机械通气并发呼吸机相关性肺炎患者的临床资料,采用Vitek 32系统对病原菌进行鉴定. 结果 276例呼吸机相关性肺炎患者早发性97例(35.14％),迟发性179例(64.86％).早发性呼吸机相关性肺炎患者共分离出105株病原菌,革兰氏阴性(G-)菌72株(68.57％)、革兰氏阳性(G+)菌21株(20.00％)和真菌12株(11.43％)；分布最多的3种病原菌为流感嗜血杆菌(22.86％)、肺炎链球菌(14.28％)和金黄色葡萄球菌(14.28％).迟发性呼吸机相关性肺炎患者共分离出186株病原菌,G-菌117株(62.90％)、G+菌54株(29.04％)和真菌15株(8.06％)；分布最多的3种病原菌为金黄色葡萄球菌(24.19％)、铜绿假单胞菌(22.58％)和肺炎克雷伯菌(14.52％).迟发性呼吸机相关性肺炎患者的病死率24.58％,明显高于早发性呼吸机相关性肺炎组患者10.31％(x2=8.14,P＜0.05),入住ICU时间和机械通气时间分别为(10.3±4.2)d、(7.8±2.7)d,明显长于早发性呼吸机相关性肺炎患者(7.8±3.1)d、(3.7±1.1)d(t=5.15、14.32,均P＜0.05). 结论 早发性与迟发性呼吸机相关性肺炎的病原菌分布具有明显差异,迟发性呼吸机相关性肺炎的预后可能更差.%Objective To compare of pathogenic bacteria characteristics between praecox and tardus ventilator-associated pneumonia (VAP) in the elderly with critical illness,and to provide the guildline and evidence of clinical prevention and treatment. Methods The clinical data of 276 VAP patients aged (69.3 ± 5.3) years in our hospital were retrospectively analyzed.There were 97cases (35.14％) with praecox VAP,179 cases (64.86％) with tardus VAP.Vitek 32 system was applied to identify pathogenic bacteria. Results In patients with praecox VAP,105 pathogenic bacteria were isolated,among which 72 cases(68.57％) suffered from G- bacterium,21 cases (20.00％) from G+ and 12 (11.43％) from fungus. The most widely distributed pathogens were hemophilus (22.86％),streptococcus pneumoniae(14.28％ ) and staphylococcus aureus(14.28％).In the patients with tardive VAP,186 pathogenic bacteria were isolated including 117(62.90％) G- bacterium,54 (29.04％)G+ bacterium and 15 (8.06％) fungus; the most widely distributed pathogens were staphylococcus aureus (24.19％), pseudomonas aeruginosa (22.58％) and klebsiella pneumoniae (14.52％).The death rate of tardus VAP(24.58％) was significantly higher than of praecox VAP (10.31％ ) (x2 =8.14,P＜0.05).The durations in ICU and mechanical ventilation were much longer in tardus VAP[(10.3±4.2)d and (7.8±2.7)d] than in praecox VAP[(7.8±3.1) d and (3.7±1.1)d] (t=5.15,14.32,P＜0.05). Conclusions There is differences in pathogenic bacteria distribution between praecox and tardus VAP,and the prognosis of tardus VAP may be worse.