摘要
目的 观察不同病原菌与呼吸机相关肺炎患者机械通气时间的关系.方法 选取2008年1月至2017年7月青海省人民医院重症医学科收治的91例呼吸机相关肺炎患者.根据痰培养结果分为单纯G+菌组、单纯G-菌组及细菌+真菌组.单纯G+菌组患者24 例,男11 例,女13例,年龄(49. 87 ± 7. 59)岁,年龄范围为39~65岁;单纯G-菌组患者32例,男17例,女15例,年龄(49. 18 ± 8. 77)岁,年龄范围为37 ~66 岁;细菌 +真菌组患者35 例,男19 例,女16 例,年龄(50. 97 ± 6. 53)岁,年龄范围为34~67岁,比较三组患者痰培养阳性结果前最近一次的血常规、生化、凝血六项及降钙素原.并运用Kaplan-Meier生存分析比较三组患者撤离呼吸机成功率的差异.结果 单纯G+菌组的血小板[(171. 75 ± 51. 28) ×109 个/L]高于单纯G-菌组[(121. 40 ± 44. 78) × 109 个/L]及细菌+真菌组[(102. 51 ± 36. 42) ×109 个/L],差异有统计学意义(P<0. 05),单纯G-菌组与细菌+真菌组比较,差异无统计学意义(P>0. 05);单纯G+菌组与单纯G-菌组白蛋白的比较,差异无统计学意义(P>0. 05),细菌+真菌组的白蛋白[(25. 42 ± 2. 10)g/L]低于单纯G+菌组[(27. 62 ± 1. 88)g/L]及单纯G-菌组[(26. 78 ± 2. 19) g/L],差异有统计学意义(P<0. 05);单纯G+菌组与单纯 G-菌组的二聚体比较,差异无统计学意义(P >0.05),细菌 + 真菌组的二聚体[(11. 94 ± 5. 79)mg/L]高于单纯G+菌组[(7. 08 ± 3. 21)mg/L]及单纯G-菌组[(9. 09 ± 3. 99)mg/L],差异有统计学意义(P<0. 05);单纯G+菌组及单纯G-菌组的降钙素原高于细菌+真菌组,但差异无统计学意义(P>0. 05);细菌+真菌组的呼吸机使用时间[(30. 42 ± 5. 53)d]显著高于单纯G+菌组[(26. 66 ± 4. 97)d]及单纯G-菌组[(21. 40 ± 4. 72)d],且单纯G+菌组的呼吸机使用时间也高于单纯G-菌组,差异有统计学意义(P<0. 05). Kaplan-Meier生存分析显示,单纯G+菌组,单纯G-菌组及细菌+真菌组呼吸机使用时间两两比较,差异均有统计意义(P<0. 05).结论 呼吸机相关肺炎真菌感染过程伴随着血小板减少及凝血、纤溶系统的激活.真菌感染可以使呼吸机使用时间明显延长.因此,在控制细菌感染的同时避免真菌的二重感染在临床上显得尤为重要.
To observe the relationship between different pathogens and mechanical ventilation time in patients with ventilator-associated pneumonia.Methods A retrospective study was per-formed on 91 cases with ventilator-associated pneumonia who were admitted between January 2008 and July 2017.The patients were divided into G+bacterial group,G-bacterial group and bacterial+fungal group according to the results of sputum culture.There were 24 patients in the G+group,including 11 males and 13 females,(49.87±7.59)years old,ranging from 39 to 65 years old;24 patients(17 males and 15 fe-males)in the G-group were(49.18±8.77)years old,ranging from 37 to 66 years old.And 35 patients in the bacterial+fungal group,including 19 males and 16 females,(50.97±6.53)years old,ranging from 34 to 67 years old.The blood routine,blood biochemistry,coagulation tests and procalcitonin were collected before the positive results of sputum culture.The differences of ventilator evacuation in each group compared by Kaplan-Meier survival analysis.Results The platelet(PLT)in G+bacterial group[(171.75±51.28)×109/L]increased significantly than G-bacterial group[(121.40±44.78)×109/L]and bacterial+fungal group[(102.51±36.42)×109/L,P<0.05],the PLT between G-bacterial group and bacterial+fungal group has no statistical difference(P>0.05).The albumin(ALB)between G+bacterial group and G-bacteria group has no statistical difference(P>0.05),the ALB in bacterial+fungal group[(25.42±2.10)g/L]dropped significantly than G+bacterial group[(27.62±1.88)g/L]and G-bacterial group((26.78±2.19)g/L,P<0.05)The D-dimer(D-D)between G+bacterial group and G-bacteria group has no statis-tical difference(P>0.05),the D-D in bacterial+fungal group[(11.94±5.79)mg/L]increased signif-icantly than G+bacterial group[(7.08±3.21)mg/L]and G-bacterial group((9.09±3.99)mg/L,P<0.05)The procalcitonin(PCT)in G+bacterial group and the G-bacterial group were higher than the bac-terial+fungal group,but the difference were not statistically significant(P>0.05).The time of ventilator use in the bacterial+fungal group[(30.42±5.53)d]was higher than the G+bacterial[(26.66±4.97)d]and G-bacterial group[(21.40±4.72)d,P<0.05],and the G+bacterial group was higher than the G-bacterial group(P<0.05).Kaplan-Meier survival analysis showed that there were statistically significant differences between G+bacteria group,G-bacteria group and bacterial+fungal group in me-chanical ventilation time(P<0.05).Conclusion The infection process of ventilator-associated pneumonia was accompanied with thrombocytopenia and the activation of coagulation,fibrinolysis system.Fungal infec-tions can prolong the use of respirators.Therefore,it is important to avoid the super infection of fungi while controlling the bacterial infection.
作者
王皓
孙斌
石青军
Wang Hao;Sun Bin;Shi Qingjun(Intensiue care medicine of Qinghai prouince people's hospital,Xining 810007,China)
出处
《中国临床实用医学》
2019年第4期17-21,共5页
China Clinical Practical Medicine
关键词
呼吸机相关肺炎
病原菌
细菌
真菌
Ventilator-associated pneumonia
Pathogens
Bacterial
Fungal
