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目的探讨老年机械通气患者发生呼吸机相关性肺炎(VAP)的原因和病原菌及耐药特点、防治措施。方法对入住ICU的651例患VAP的老年患者进行目标性监测。结果3年内在ICU行机械通气的老年患者350例发生VAP182例,气管切开、昏迷、皮质激素、长期使用抗菌药物及通气时间延长是发生VAP的重要原因;VAP的病原菌以革兰阴性杆菌为主,铜绿假单胞菌占首位(23.6%);革兰阴性杆菌对常用的抗菌药物耐药率高。结论VAP的病原菌以革兰阴性杆菌为主,耐药率高,缩短机械通气时间,合理使用抗菌药物、加强消毒隔离有助于VAP的防治。
Objective To investigate the causes of ventilator-associated pneumonia (VAP) in elderly patients with mechanical ventilation and the characteristics of pathogens, drug resistance and prevention and treatment. Methods Targeted monitoring of 651 elderly patients with VAP admitted to the ICU was performed. Results VAP 182 cases, tracheotomy, coma, corticosteroids, long-term use of antibiotics and prolonged ventilation time were the main reasons for the occurrence of VAP in 350 elderly patients with mechanical ventilation in ICU within 3 years. The pathogens of VAP were gram-negative bacilli The main, Pseudomonas aeruginosa accounted for the first (23.6%); Gram-negative bacilli commonly used antimicrobial resistance rate. Conclusions Gram-negative bacilli are the main pathogens of VAP. The drug resistance rate is high, the duration of mechanical ventilation is shortened, antimicrobial agents are used reasonably, and disinfection and isolation are helpful to the prevention and treatment of VAP.