23例呼吸机相关性肺炎患者临床研究.doc

23例呼吸机相关性肺炎患者临床研究【摘要】目的观察呼吸机相关性肺炎(VAP)患者的临床特点,应用急性生理学及慢性健康状况评价系统Ⅱ(APACHEⅡ评分),分析其预后的相关因素和防治方法。方法观察23例呼吸机相关性肺炎患者的临床资料,并以机械通气未出现VAP的22例患者为对照组,进行比较和APACHEⅡ评分。结果23例呼吸机相关性肺炎患者中,单纯致病菌17例,二种及二种以上致病菌 6例。病原菌培养结果:铜绿假单胞菌12例、金黄色葡萄球菌10例、克雷伯杆菌6例,白色念珠菌4例,大肠埃希菌3例。结论铜绿假单胞菌、金黄色葡萄球菌、克雷伯杆菌、白色念珠菌是呼吸机相关性肺炎主要致病菌;针对产生呼吸机相关性肺炎的原因进行积极防治是缩短机械通气时间和提高生存率的重要措施;APACHEⅡ评分系统有助于预测机械通气患者VAP的发生,评估病情的严重性、住院时间和预后。 【关键词】机械通气 呼吸机相关性肺炎 APACHEⅡ评分 中图分类号:R563 文献标识码:A 文章编号:1005-0515(2010)07-097-02 Clinical analysis of 23 cases of ventilator associated pneumonia XU Zhaoyong XIE Donghui 【Abstract】ObjectiveTo observe cases of ventilator-associated pneumonia, evaluate its effects on prognosis and determine prevention and treatment measures with the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) . Methods23 patients with ventilator-associated pneumonia were observed, 22 patients with mechanical ventilation and non-VAP were divided into control groups,and evaluated with APACHEⅡscore system and clinical ways. ResultsAmong the 23 patients with ventilator-associated pneumonia, 17 cases had one type of pathogen and 6 cases had two or more types of pathogen. The pathogen culture results is as follows: 12 cases were positive for bacillus pyocyaneus , 10 cases had staphyl ococcus aureus, 6 case had bacillus klebsiella, 4 cases had candida, 3 cases had Escherichia coli .ConclusionsBacillus pyocyaneus , staphylococcus aureus , bacillus klebsiella and candida are the most common pathogens among ventilator-related pneumonia cases . According to the cause of ventilator-related pneumonia, active prevention and treatment can shorten the time of mechanical ventilation and improve chances of survival . APACHEⅡ score systems in highly valuable in predicting the VAP and evaluating the severity of illness, in hospital time and prognosis with VAP. 【Key words】Mechanical ventilation ventilator-associated pneumonia APACHEⅡscore systems 目前,机械通气已成为抢救急诊、危重症患者的重要手段之一,但随着机械通气在临床越来越广泛的应用,呼吸机相关性肺炎(Ventilator-associ