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目的:探讨重症监护室老年患者呼吸机相关肺炎(VAP)发生的危险因素,并对病原菌进行分析。方法:回顾性分析2012-01-2014-12入住我院ICU的年龄大于60岁的气管插管或气管切开的机械通气患者的临床资料。结果:APACHEⅡ评分≥15分、机械通气时间≥7d及使用抑酸药物>3d是VAP发生的危险因素。细菌培养检出病原菌386株,其中革兰氏阴性菌302株(78.2%),革兰氏阳性菌45株(11.7%),真菌39株(10.1%),VAP感染的主要病原体为革兰氏阴性菌,且呈现多重耐药现象。结论:老年患者VAP的发生涉及多种危险因素,致病菌以革兰氏阴性菌为主,且耐药现象严重。为降低VAP的发生率,应对机械通气的患者进行全面预防,合理使用抗生素。
Objective: To explore the risk factors of ventilator-associated pneumonia (VAP) in elderly patients in intensive care unit and to analyze the pathogens. Methods: The clinical data of patients with mechanical ventilation over 60 years who underwent tracheal intubation or tracheostomy admitted to our hospital from January 2012 to December 2014 were retrospectively analyzed. Results: APACHE Ⅱ score ≥ 15 points, mechanical ventilation ≥ 7d and the use of acid-suppressing drugs> 3d were the risk factors of VAP. Bacterial culture detected 386 pathogens, of which 302 were Gram-negative bacteria (78.2%), 45 (11.7%) were Gram-positive bacteria and 39 (10.1%) were fungi. The main pathogens of VAP infection were Gram Negative bacteria, and the phenomenon of multi-drug resistance. Conclusion: The incidence of VAP in elderly patients involves a variety of risk factors, mainly gram-negative bacteria, and the drug resistance is serious. To reduce the incidence of VAP, patients should be fully ventilated mechanical prophylaxis, the rational use of antibiotics.