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目的:调查了解重症监护室(ICU)气管插管患者肺部感染发生情况及病原菌、耐药性与相关影响因素,为采取防控措施提供依据。方法:选择我院ICU气管插管患者550例,对患者的性别、年龄、基础疾病、全身麻醉、手术部位、意识障碍、住院时间、急诊手术、长期大量吸烟史等进行统计,分析肺部感染的相关影响因素;采集患者的痰液,进行细菌培养和药敏试验。结果:本组550例中,共发生肺部感染132例,占24.0%。年龄大小、有无基础疾病、是否全身麻醉、手术部位、有无意识障碍、住院时间长短、是否急诊手术、气管插管留置时间、有无吸烟史及预防性应用抗菌药物等,是影响肺部感染显著或非常显著因素(P<0.05,P<0.01)。在肺部感染132例中,原发病位居前3位分别为神经系统疾病41例(31.1%)、胸部及心血管系统疾病31例(23.5%)和肝胆及肠道系统疾病27例(20.5%)。肺部感染132例中,共培养出病原菌155株,其中革兰阳性菌39株(25.2%),革兰阴性菌111株(71.6%),真菌5株(3.2%)。经药敏试验,革兰阳性菌金黄色葡萄球菌对18种常用抗生素除对达福普丁、达托霉素、利奈唑胺和万古霉素没有耐药性外,其余品种均有不同程度耐药,其中氨苄西林耐药率达100.0%;革兰阴性菌肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌、鲍曼不动杆菌等对15种常用抗生素药敏试验,除对亚胺培南和美罗培南敏感外,其余品种均存在不同程度耐药。结论:ICU气管插管患者发生肺部感染率较高,多为耐药菌感染,且与年龄>60岁、脑胸腹部手术、住院时间>7天、全身麻醉、气管导管留置时间大于4天、意识障碍、长期吸烟史等因素有关,应采取相应措施加以防控。
Objective: To investigate the incidence of lung infection, pathogens, drug resistance and related factors in patients with intensive care unit (ICU) tracheal intubation and provide evidence for prevention and control measures. Methods: A total of 550 ICU tracheal intubation patients were selected in our hospital to analyze the gender, age, underlying diseases, general anesthesia, surgical site, disturbance of consciousness, length of hospital stay, emergency operation and long-term smoking history. Of the relevant factors; sputum collected patients, bacterial culture and susceptibility testing. Results: Among the 550 cases in this group, there were 132 cases of pulmonary infection, accounting for 24.0%. Age, size, presence or absence of underlying disease, general anesthesia, site of surgery, unconsciousness, duration of hospitalization, emergency surgery, endotracheal intubation time, smoking history, and prophylactic use of antimicrobial agents are factors affecting the lung infection Significant or very significant (P <0.05, P <0.01). Among the 132 cases of pulmonary infection, the top three primary diseases were neurological diseases in 41 cases (31.1%), thoracic and cardiovascular diseases in 31 cases (23.5%) and hepatobiliary and intestinal diseases in 27 cases 20.5%). Among 132 cases of pulmonary infection, 155 strains of pathogens were cultured, of which 39 were gram-positive bacteria (25.2%), 111 (71.6%) were gram-negative bacteria and 5 were fungi (3.2%). The susceptibility test, Gram-positive Staphylococcus aureus 18 kinds of commonly used antibiotics in addition to dafuddin, daptomycin, linezolid and vancomycin no resistance, the other varieties have different levels of resistance Among them, the antibiotic susceptibility of ampicillin reached 100.0%. The antibiotic susceptibility tests of 15 commonly used antibiotics of Gram-negative bacteria such as Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae and Acinetobacter baumannii, Pei Nan and Meropenem sensitive, the rest of the species are resistant to varying degrees. CONCLUSIONS: The incidence of pulmonary infection in patients with ICU tracheal intubation is high, mostly resistant to drug-resistant bacterial infection, and more than 4 days with age> 60 years, brain-chest abdominal surgery, hospital stay> 7 days, general anesthesia, tracheal catheter indwelling time , Disturbance of consciousness, long-term smoking history and other factors, we should take appropriate measures to prevent and control.