摘要
目的探讨开胸术后多药耐药鲍氏不动杆菌(MDRAB)重症肺炎的防治经验。方法回顾性分析2008年10月-2010年6月19例MDRAB重症肺炎(观察组)资料,并与2006年1月-2010年6月33例非MDRAB重症肺炎(对照组)的病例资料对比分析,将观察组患者分为死亡组和痊愈组,分析影响MDRAB重症肺炎预后的因素。结果开胸术后MDRAB重症肺炎的住院时间和住院费用明显增加、MODS发生率和死亡率无明显上升,是否并发多重感染(血液、深部真菌)、术后舒巴坦/替加环素治疗时机、经济状况3项指标与MDRAB重症肺炎的预后有关。结论开胸术后MDRAB重症肺炎的危害性在于导致感染患者术后住院时间延长、住院费用上升,加大舒巴坦剂量经验性治疗、避免菌群失调并发症、加强丙种球蛋白及营养支持,是目前治疗MDRAB重症肺炎的主要措施,做好ICU清洁卫生、彻底消毒呼吸机管道和纤维支气管镜、及时隔离感染患者是避免MDRAB感染蔓延的重要措施。
OBJECTIVE To explore the experience in prevention and treatment of severe pneumonia caused by multidrug resistant Acinetobacter baumannii （MDRAB） after thoracotomy. METHODS A retrospective analysis was conducted in 19 patients （observation group） with MDRAB-related pneumonia from Oct 2008 to Jun 2010 after thoracotomy. In addition, 33 no MDRAB positive patients with severe pneumonia from Jan 2006 to Jun 2010 were recruited as control group for the comparative analysis. Patients from the observation group were further divided into death group and recovery group, and the influencing factors of prognosis of MDRAB-related pneumonia were were analyzed. RESULTS The hospitalization time and maintenance charge of patients with MDRAB-related pneumonia significantly increased, but there was no significant difference in the multiple organ dysfunction syndrome （MODS） incidence or mortality. Complication with multiplicity of infection （blood, deep fungus）, timing of sulbactam/tigecycline treatment and financial condition were the three factors correlated with the prognosis of severe MDRAB pneumonia. CONCLUSION The-MDRAB-related pneumonia after thoracotomy resulted in the extension of hospitalization time and increase of maintenance charge. Currently, the major treatments of severe MDRAB-related pneumonia are empirical therapy using large dose of sulbactam, intensive use of gamma globulin and supportive treatment. Keep the ICU clean, keep the pipe system of breathing machine sterile, and promptly isolate the infected patients are the important measures to avoid the spread of MDRAB infection.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2012年第1期67-69,共3页
Chinese Journal of Nosocomiology
关键词
多药耐药
鲍氏不动杆菌
肺部感染
治疗
Multidrug-resistance
Acinetobacterbaumannii
Pulmonary infection
Therapy
