【摘要】：目的分析遲發(fā)型呼吸機相關性肺炎(VAP)的臨床特點及病原菌的分布,并與早發(fā)型VAP作一比較,為臨床經(jīng)驗性用藥提供參考依據(jù)。方法選取2010年3月-2012年11月103例VAP患者,按照發(fā)生VAP的時間不同分為早發(fā)型及遲發(fā)型,比較兩者在臨床特征、病原學及預后的差異;采用SPSS17.0軟件進行分析,計量資料以均數(shù)±標準差表示,組間計量資料比較采用t檢驗,計數(shù)資料采用χ2檢驗。結果早發(fā)型VAP組79例患者痰培養(yǎng)陽性58例,陽性率為73.4%,分離出病原菌73株,以鮑氏不動桿菌、洋蔥伯克霍爾德菌、MRSA、肺炎克雷伯菌為主,分別占16.4%、15.1%、15.1%、13.7%;遲發(fā)型VAP組24例患者痰培養(yǎng)陽性20例,陽性率為83.3%,分離出病原菌33株,以鮑氏不動桿菌、洋蔥伯克霍爾德菌、肺炎克雷伯菌、銅綠假單胞菌為主,分別占21.2%、18.2%、18.2%、12.1%;兩組患者的簡化急性生理學評分Ⅱ(SAPSⅡ)、5d內(nèi)發(fā)生急性呼吸窘迫綜合征(ARDS)的例數(shù)、機械通氣時間、住ICU時間及預后比較,差異有統(tǒng)計學意義(P0.05)。結論 SAPSⅡ評分高及發(fā)生ARDS的患者發(fā)生遲發(fā)型VAP的概率更高,鑒于遲發(fā)型VAP患者二重感染的發(fā)生率更高,臨床可能更需要聯(lián)合用藥。
[Abstract]:Objective to analyze the clinical characteristics and the distribution of pathogenic bacteria in delayed ventilator associated pneumonia (VAP) and compare it with early onset VAP in order to provide reference for clinical experience. Methods from March 2010 to November 2012, 103 patients with VAP were divided into early onset and delayed onset according to the time of onset of VAP. The clinical characteristics, etiology and prognosis of the two patients were analyzed by SPSS17.0 software. The measurement data were expressed as mean 鹵standard deviation. T test and 蠂 2 test were used to compare the measurement data among groups. Results in the early onset VAP group, 58 cases were positive in sputum culture, the positive rate was 73.4%. 73 strains of pathogenic bacteria were isolated, including Acinetobacter baumannii, Burkholderia cepacia, Klebsiella pneumoniae. In the delayed type VAP group, 20 cases were positive in sputum culture, the positive rate was 83.3%, 33 strains of pathogenic bacteria were isolated, mainly Acinetobacter baumannii, Bacillus cepacia, Klebsiella pneumoniae, Pseudomonas aeruginosa. There were significant differences between the two groups in the number of patients with acute respiratory distress syndrome (ARDS), the duration of mechanical ventilation, the duration of ICU residence and prognosis within 5 days after the onset of acute respiratory distress syndrome (ARDS) in the two groups (P0.05). Conclusion patients with high SAPS 鈪，

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