摘要
目的分析呼吸重症监护室(RICU)医院获得性肺炎(HAP)病原学分布及危险因素。方法回顾性分析2017年1月—2018年1月本院RICU收治的393例HAP患者(研究组)和同期393例非HAP患者(对照组)的临床资料。观察研究组HAP患者病原学分布特点,分析影响RICU患者患HAP的危险因素。结果393例HAP患者痰培养检出病原菌503株,其中革兰阴性杆菌338株(67.19%),革兰阳性菌37株(7.36%),真菌128株(25.45%);主要病原菌为鲍曼不动杆菌、白假丝酵母菌、铜绿假单胞菌和金黄色葡萄球菌。研究组年龄≥60岁、入RICU时间>7 d、APACHEⅡ评分>15分、意识障碍、使用镇静剂、使用抑酸剂、机械通气、留置管路(胃管、尿管、中心静脉置管)、抗生素使用≥2种患者比例及白蛋白水平显著高于对照组(P<0.05)。Logistic回归分析显示,年龄≥60岁、APACHEⅡ评分>15分、机械通气、抗生素使用≥2种是影响RICU患者患HAP的独立危险因素(P<0.05)。结论RICU HAP患者病原菌分布以革兰阴性菌为主,真菌及革兰阳性菌中金黄色葡萄球菌占较高比例,针对高危人群应积极治疗基础疾病,重视机械通气护理,根据药敏试验结果合理应用抗生素,为HAP的防治提供帮助。
Objective To analyze the etiological distribution and risk factors of hospital acquired pneumonia(HAP)in respiratory intensive care unit(RICU).Methods The clinical data of 393 HAP patients(study group)and 393 non-HAP patients(control group)those ever hospitalized in RICU of our hospital from January 2017 to January 2018 were retrospectively analyzed.The etiological distribution features of HAP patients in study group were observed,and the risk factors affecting HAP patients in RICU were analyzed.Results 503 strains of pathogenic bacteria were isolated from the 393 cases of HAP patients,including 338 strains(67.19%)of gram-negative bacilli and 37 strains(7.36%)of gram-positive bacilli and 128 strains(25.45%)of fungi.The most common pathogens were acinetobacter baumannii,Candida albicans,Pseudomonas aeruginosa and Staphylococcus aureus.The proportions of patients those elder than and/or equal to 60 years old,RICU stay longer than 7 days,APACHEⅡscore more than15 points,mental disturbance,use of sedatives,use of acid-suppressant,mechanical ventilation,indwelling tubes(stomach tube,urinary catheter,central venous catheter)and antibiotic use more than and/or equal to 2 kinds and the albumin level in study group were significantly higher than those in control group(P<0.05).Logistic regression analysis showed that age≥60 years old,APACHEⅡ score>15 points,mechanical ventilation and antibiotic use≥2 kinds were independent risk factors of HAP for patients in RICU(P<0.05).Conclusions The distribution of pathogenic bacteria of HAP patients in RICU is mainly gram-negative bacteria,and the Staphylococcus aureus in fungi and gram-positive bacteria also accounts for a relatively high proportion.For high-risk groups,basic diseases should be actively treated and mechanical ventilation should be emphasized,and the antibiotics should reasonably apply based on the results of drug susceptibility test so as to help prevent and treat HAP.
作者
王水雯
WANG Shui-wen(The third affiliated hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,450000,China)
出处
《齐齐哈尔医学院学报》
2020年第21期2704-2707,共4页
Journal of Qiqihar Medical University
关键词
呼吸重症监护室
医院获得性肺炎
病原学分布
危险因素
Respiratory intensive care unit
Hospital acquired pneumonia
Etiological distribution
Risk factors
