儿童感染菌的分布与呼吸相关性肺炎的病原菌分析-第三军医大学学报.docVIP

呼吸机相关性肺炎病原学诊断及菌谱研究 罗雁红 卢仲毅 许峰 匡凤悟 邓兵 刘昌龄 朱军 重庆医科大学儿童医院PICU 400014 [摘要]目的 探讨呼吸机相关性肺炎（VAP）的病原学诊断、菌谱及致病相关因素。方法 对我院PICU 83例机械通气患儿资料进行总结分析，其中31例同时采用两种方法获取痰培养结果比较分析。结果 机械通气患儿感染菌分别以铜绿假单胞菌，鲍曼不动杆菌，脑膜败血型黄杆菌占前3位。VAP感染菌分别以铜绿假单胞菌，鲍曼不动杆菌，真菌占前3位。两种方法检出的病原菌差异有显著性意义(p0.05)。结论 G-杆菌已成为机械通气和VAP患儿的优势菌群，对临床常用抗生素均有多重耐药现象。PSB和BAL技术优于一次性无菌吸痰管从气管插管内深部吸取分泌物的方法。 [关键词] 病原菌谱/呼吸机相关性肺炎/诊断 中图分类号：R563.108 文献标识码：A 文章编号： Bacterial spectrum anlysis and diagnosis of ventilator-associated pneumonia Luo yanhong, Lu zhongyi, Xu feng, Kuang fengwu, Deng bing, Liou changling, Zhu jun PICU Childrens Hospital, Chongqing University of Medical Sciences 400014 [Abstract] Objective: To investigate the bacterial spectrum diagnosis and the result that related factor in disease of ventilator-associated pneumonia. Methods: Specimens cultured for bacterial isolated from 83 cases with mechanical ventilator were analysed. Thereinto 31 to adopt at the same time two kinds of methods obtains the phlegm fosters the result compares the analysis. Results: The main organisms with mechanical ventilator were Pseudomonas aeruginosa,Acinetobacter baumannii and C.meningoseptic. The main organisms with VAP were Pseudomonas aeruginosa,Acinetobacter baumannii and Fungi.The original germ in disease distinct difference that two kinds of methods(P0.05) Conclusion: Gram negative bacilli have become the major pathogens in cases with mechanical ventilator and causing VAP ,Which put up multi-resistance to most commonly used antibiotics. the technique of BAL and PSB surpasses with that of a the time has no germ inhale phlegm tube to take from the windpipe the deep department in inside absorbs the secretion method. [Key Words]:Bacterial spectrum /Ventilator-associated pneumonia/ diagnosis 随着现代医疗技术的不断提高，在ICU接受呼吸机治疗的患儿日渐增多，但也带来了呼吸机相关性肺炎（Ventilator—associated pneumonia VAP）这一并发症的增多，加之现在抗生素的广泛应用，新的耐药菌株在不断产生，又不易获得准确病原菌诊断。VAP预后严重，治疗棘手，已成为应用机械通气患儿最主要的并发症及致死原因[1-2]，是当前ICU急待解决的难题。本文对83例机械通气患儿痰培养的病原学资料进行了相关分析及病原菌诊断两种方法进行比较分析如下： 1.对象及方法 1.