本文選題：呼吸機(jī)相關(guān)性肺炎 + 病原菌��； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過研究邛崍市醫(yī)療中心醫(yī)院重癥監(jiān)護(hù)病房(ICU)呼吸機(jī)相關(guān)性肺炎(VAP)住院患者的臨床特點(diǎn)、病原菌的耐藥性以及VAP相關(guān)危險(xiǎn)因素,為臨床上預(yù)防及個(gè)體化治療VAP提供科學(xué)依據(jù)。方法:邛崍市醫(yī)療中心醫(yī)院2015年01月 2016年10月472例ICU住院患者納入本次研究,收集患者年齡、性別、APACHEII評(píng)分、意識(shí)狀態(tài)、口咽部微生物定植、胃液微生物定植、濕化器微生物定植、冷凝器微生物定植、螺紋管微生物定植、H2受體阻斷劑應(yīng)用、機(jī)械通氣時(shí)間及機(jī)械通氣方式、VAP發(fā)病情況等資料,采用單因素及Logistic回歸分析危險(xiǎn)因素;對(duì)發(fā)生VAP的住院患者用無菌吸痰管從下呼吸道采集分泌物先進(jìn)行痰涂片檢查合格后再進(jìn)行細(xì)菌培養(yǎng),所有菌株采用VITEK微生物全自動(dòng)分析儀進(jìn)行細(xì)菌鑒定,并對(duì)分離出的主要菌株用K-B法對(duì)常用抗生素進(jìn)行藥敏實(shí)驗(yàn),以美國臨床和實(shí)驗(yàn)室標(biāo)準(zhǔn)化協(xié)會(huì)(CLSI)2014版判斷標(biāo)準(zhǔn)判斷藥敏結(jié)果。結(jié)果:(1)本組472患者有184例發(fā)生VAP,發(fā)生率為38.98%。(2)單因素分析結(jié)果顯示,患者年齡、APACHEII評(píng)分、意識(shí)狀態(tài)、口咽部微生物定植、機(jī)械通氣時(shí)間、濕化器微生物定植、冷凝器微生物定植、螺紋管微生物定植及機(jī)械通氣方式等因素與VAP發(fā)生有關(guān)(P0.05),而患者性別、胃液微生物定植、H2受體阻斷劑等因素與VAP發(fā)生無關(guān)(P0.05)。(3)Logistic回歸分析結(jié)果顯示,年齡、APACHEII評(píng)分、機(jī)械通氣時(shí)間、機(jī)械通氣方式和濕化器微生物定植是VAP的影響因素。(4)送檢樣本中分離病原菌141株,其中革蘭陽性菌21株(14.89%)、革蘭陰性菌101株(71.63%),真菌19株(13.48%)。(5)本組檢出率最高的病原菌依次為鮑曼不動(dòng)桿菌34株(23.94%)、肺炎克雷伯菌28株(19.86%)、白假絲酵母菌17株(12.06%)、銅綠假單胞菌16株(11.35%)、金黃色葡萄球菌11株(7.80%)。(6)鮑曼不動(dòng)桿菌對(duì)舒巴坦、亞胺培南、青霉素類和頭孢類抗生素耐藥率較高,對(duì)復(fù)方新諾明耐藥率較低。(7)肺炎克雷伯菌對(duì)頭孢拉定、阿莫西林和氨芐西林耐藥率達(dá)100%,對(duì)頭孢他啶和哌拉西林敏感,對(duì)亞胺培南、氨曲南和左氧氟沙星耐藥率較低,對(duì)頭孢類抗生素耐藥率均較高。(8)銅綠假單胞菌對(duì)慶大霉素和妥布霉素敏感,對(duì)亞胺培南、左旋氧氟沙星及環(huán)丙沙星耐藥率較低,對(duì)大多數(shù)頭孢類抗生素耐藥率較高。(9)金黃色葡萄球菌對(duì)除阿莫西林外其他常用抗生素耐藥率較低,對(duì)呋喃妥因、慶大霉素及復(fù)方新諾明均不耐藥。(10)大腸埃希菌對(duì)多種抗菌藥物耐藥,對(duì)青霉素類、頭孢類及喹諾酮抗生素類幾乎完全耐藥,對(duì)哌拉西林他唑巴坦耐藥率較低,但對(duì)亞胺培南敏感。結(jié)論:(1)邛崍市醫(yī)療中心醫(yī)院重癥監(jiān)護(hù)病房(ICU)住院患者VAP病原菌感染形勢嚴(yán)峻。(2)VAP的發(fā)生與患者年齡、APACHEII評(píng)分、濕化器微生物定植、機(jī)械通氣時(shí)間以及機(jī)械通氣方式有關(guān)。(3)VAP病原菌以革蘭氏陰性桿菌為主,并有多重耐藥。
[Abstract]:Objective: to study the clinical characteristics of patients with ventilator associated pneumonia (VAP) in the intensive care unit (ICU) of Qionglai City Medical Center Hospital, the drug resistance of pathogenic bacteria and the risk factors associated with VAP. To provide scientific basis for clinical prevention and individualized treatment of VAP. Methods: 472 ICU inpatients from January 2015 to October 2016 in Qionglai City Medical Center Hospital were included in the study. The patients' age, sex and Apache II scores, consciousness status, oropharyngeal microorganism colonization and gastric juice microorganism colonization were collected. The data of humidifier microorganism colonization, condenser microorganism colonization, threaded tube microorganism colonization and H _ 2 receptor blocker application, mechanical ventilation time and mechanical ventilation mode were analyzed by single factor and Logistic regression analysis. Sputum smears were collected from the lower respiratory tract with aseptic sputum suction tube in the inpatients with VAP. All the strains were identified by VITEK microorganism automatic analyzer. K-B method was used to test the susceptibility of common antibiotics, and the results were judged by CLSI 2014 standard of American Association of Clinical and Laboratory Standardization. Results among the 472 patients, 184 cases (38.98%) developed VAPs. The results of univariate analysis showed that the age of the patients was APACHEII score, consciousness state, oropharyngeal microorganism colonization, mechanical ventilation time, humidifier microorganism colonization, condenser microorganism colonization. Factors such as microbiological colonization of threaded tube and mechanical ventilation mode were related to the occurrence of VAP (P 0.05), but the sex of patients, gastric microorganism colonization and H 2 receptor blocker were not related to the occurrence of VAP. Logistic regression analysis showed that age, Apache II score and mechanical ventilation time were not related to the occurrence of VAP. Mechanical ventilation and humidifier microorganism colonization were the influencing factors of VAP. Among them, 21 strains of Gram-positive bacteria, 101 strains of Gram-negative bacteria, and 19 strains of fungi, respectively, have the highest detectable rate of Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella pneumoniae, Candida albicans, Candida albicans, Pseudomonas aeruginosa, and Pseudomonas aeruginosa, respectively. 16 strains of Acinetobacter baumannii, 11 strains of Staphylococcus aureus, 11 strains of Staphylococcus aureus, The resistance rate of imipenem, penicillin and cefazolin antibiotics was higher, and the resistance rate of Klebsiella pneumoniae to cefradine, amoxicillin and ampicillin was 100, and was sensitive to ceftazidime and piperacillin, and the resistance rate of Klebsiella pneumoniae to cefradine, amoxicillin and ampicillin was 100%, and it was sensitive to ceftazidime and piperacillin. The resistance rates to imipenem, aztreonam and levofloxacin were lower, and those to cephalosporin antibiotics were higher. Phaeomonas aeruginosa were sensitive to gentamicin and tobramycin, but to imipenem, levofloxacin and ciprofloxacin. Staphylococcus aureus has a lower resistance rate to other commonly used antibiotics except amoxicillin, and is more resistant to furantoin, while Staphylococcus aureus has higher resistance to most cephalosporins. Escherichia coli was resistant to many antibiotics, almost completely to penicillin, cephalosporins and quinolones, but low to piperacillin tazobactam. But sensitive to imipenem. Conclusion (1) in the intensive care unit (ICU) of Qionglai City Medical Center Hospital, the incidence of VAP pathogenic bacteria infection in the inpatients was severe, and the age of the patients was evaluated with Apache II score, and the humidifier microorganism was colonized. The main pathogens of VAP were Gram-negative bacilli and multidrug resistance.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.1

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