多发伤患者呼吸机相关性肺炎的特点及防治对策

摘要

Objective To investigate the incidence rate,the pathogens distribution and the drug sensitivity tests characteristics of the ventilator-associated pneumonia in muhiple-injury patients,analyze the influencing factors on ventilator-associated pneumonia in multiple-injury patients and then provide the preventing and curing strategies.Methods We studied the clinical datas of 134 multiple-injury patients who were admitted in the People' s Hospital of Yunfu from Jan.2005 to Jan.2010,and with mechanical ventilation over 48 hoursoResults We found 60 patients superinduced ventilator-associated pneumonia in the whole 134 multiple-injury patients,the incidence rate of VAP was 44.8％,including 20 patients of early-onset VAP,and the other 40 patients were late-onset VAP.160 pathogenic bacteria isolates were found in the 60 VAP patients,they mainly included pseudomonas aeruginosa,aureus staphylococcus,klebsiella pneumoniae,enterobacter cloacae and acinetobacter baumannii.35 patients were found carrying over 2 kinds of pathogens,and the other 25 patients took only 1 pathogen.Also,the trauma severity scaling,the duration of mechanical ventilation,the ICU stay and the level of blood loss of the VAP patients all significantly had close relation with infection.Conclusions The incidence rate of VAP was so high in multiple-injury patients,and it can directly influence the prognosis,so we should use complex therapies to remove relevant high risk factors to avoid VAP.%目的 探讨多发伤患者呼吸机相关性肺炎(VAP)的发病率和病原菌分布以及药敏试验特点,并对VAP影响因素进行分析及提出防治策略.方法 对云浮市人民医院综合ICU于2005年1月-2010年1月收治的多发伤患者进行机械通气＞48h的134例患者临床资料进行分析.结果 134例患者并发VAP有60例,发病率为44.8％,其中早发性VAP 20例、晚发性VAP40例,60例患者共检出病原菌160株,主要是铜绿假单胞菌、金色葡萄球菌、肺炎克雷杆菌、大肠阴沟杆菌、鲍氏不动杆菌.35例检出≥2种病原菌,25例单检出1种病原菌.患者创伤评分、APACHEⅡ评分、呼吸机使用时间、ICU住院时间、失血严重程度等因素与VAP发生有显著相关性.结论 多发伤患者VAP发病率高,且直接影响预后,必须采取综合措施,预防控制易患因素,降低VAP的发生.