肿瘤患者ICU呼吸机相关性肺炎61例临床分析.docVIP

精品论文 参考文献 肿瘤患者ICU呼吸机相关性肺炎61例临床分析 袁月 王宏丽 　　（四川成都363医院ICU四川成都610000） 　　【摘要】目的：分析某院肿瘤患者呼吸机相关性肺炎（VAP）的流行病学特点、危险因素、病原菌构成及耐药情况，对临床诊断和治疗提供参考。方法：选择2010.1～2012.12某医院收治的248例肿瘤患者，其中入住ICU并发生VAP感染的61例进行分析。结果：该院肿瘤患者ICU呼吸机相关性肺炎的感染率为246%，主要致病菌为革兰阴性杆菌，其中以鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯杆菌为主。革兰阳性菌以金黄色葡萄球菌为主，真菌感染以白色念珠菌和曲霉菌为主。结论：该院肿瘤患者ICU呼吸机相关肺炎感染率较高，以革兰阴性杆菌为主，耐药率普遍较高，应根据病原学合理使用抗生素，预防VAP的发生。 　　【关键词】呼吸机相关肺炎；医院感染；病原菌；危险因素Analysis of 61 patients with ventilator-associated-pneumonia and cancer in medical ICU 　　Yuan YueWang Hongli(Department of ICU,363 hospital，Chengdu,Sichuan province 610100,China.) 　　【Abstract】Objective To study the epidemiological characteristics，risk factors,the aetiological characteristics and bacterial susceptibility in patients with ventilator-associated-pneumonia.Methods To review the 61 patients with ventilator-associated-pneumonia and cancer in medical ICU from January 2010 to December 2012Results 246% of patients suffered from the VAP.The main pathogenic bacterium were Gram-Negative bacillus,including Acinetobacter baumannii,Pseudomonas aeruginosa and klebsiella pneumoniae.Gram-positive coccus were chiefly Straphloclccus aureus and fungi were Blastomces alblicans and Aspergillus.Conclusion Infection rates of ventilator-associated pneumonia in ICU of the hospital are high.The dominant bacterium in patients with VAP was GNB,and all bacteria showed high ressitance to common antibiotics.Clinical tactics emphasis select suitable antibiotics on the basis of aetiological analysis and integrated control.Preventing risk factors of nosocomial infection should be taken as appropriate control measures. 　　【Key words】ventilator-associated-pneumonia；nosocomial infection;pathogen;risk factors 　　【中图分类号】R197324【文献标识码】B【文章编号】1003-5028(2013)10-0221-02 　　 　　呼吸机相关性（Ventilatorassociatedpneumonia,VAP）是ICU机械通气患者常见和严重的并发症之一，尤其是对于本身免疫力就低下的肿瘤患者来说，更容易发生。目前报道VAP的发病率达9~70%，病死率为33~71%［1］，患者发生VAP后，不仅增加了住院时间和费用，影响治疗效果，而且大量广谱抗生素的应用也使病原菌耐药率明显增加。VAP是ICU患者死亡的主要原因之一，本文旨在对VAP进行临床分析，了解其相关危险因素及主要病原菌种类、耐药情