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目的探讨新生儿呼吸机相关性肺炎(VAP)的发生因素及病原菌分布,为临床预防提供依据。方法回顾性分析2008年1月-2012年12月新生儿重症监护病房(NICU)中机械通气≥48h的364例患儿临床资料,对其中64例发生VAP的患儿在气管插管下取其痰液标本做细菌培养及药敏试验。结果 364例机械通气≥48h的患儿中发生VAP 64例,发生率为17.58%,住院时间、出生体质量、胎龄、母亲年龄、机械通气时间、插管次数为VAP发生的危险因素(P<0.05);共培养出病原菌60株,其中革兰阴性菌56株,占93.3%,主要病原菌为肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌及阴沟肠杆菌等;肺炎克雷伯菌对环丙沙星的敏感性最强,敏感率为81.82%,对亚胺培南、美罗培南、庆大霉素等药物的敏感性明显下降,敏感率分别为72.73%,77.27%,68.18%。结论 VAP的发生相关因素较多,革兰阴性菌为主要病原菌,应对VAP患儿的痰液标本进行细菌培养及药敏试验,依据结果选择合适的抗菌药物治疗,同时采取相应的预防措施,减少VAP的发生。
Objective To investigate the occurrence of neonatal ventilator-associated pneumonia (VAP) and the distribution of pathogens to provide the basis for clinical prevention. Methods The clinical data of 364 children with mechanical ventilation≥48h in neonatal intensive care unit (NICU) from January 2008 to December 2012 were retrospectively analyzed. Totally 64 children with VAP underwent intubation Sputum specimens for bacterial culture and susceptibility testing. Results VAP occurred in 364 children with mechanical ventilation≥48h, with a incidence rate of 17.58%, length of hospital stay, birth weight, gestational age, age of the mother, duration of mechanical ventilation and number of intubation were the risk factors for VAP <0.05). Sixty strains of pathogens were co-cultivated, of which 56 were Gram-negative bacteria, accounting for 93.3%. The main pathogens were Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii and Enterobacter cloacae, Sensitivities of Klebsiella pneumoniae to ciprofloxacin were the highest, the sensitivities were 81.82%, the sensitivity to imipenem, meropenem and gentamycin were significantly decreased, the sensitivity rates were 72.73%, 77.27% , 68.18%. Conclusions There are many related factors of VAP occurrence. Gram - negative bacteria are the main pathogenic bacteria. Bacterial culture and drug sensitivity test should be performed on sputum samples from children with VAP. According to the results, appropriate antibacterial drugs should be selected and corresponding preventive measures should be taken to reduce The occurrence of VAP.