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目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)的危险因素及病原菌的分布、耐药情况,为临床防治提供依据。方法以ICU内行机械通气的186例患者为分析对象,将其分为VAP组与非VAP组,对可能引起呼吸机相关性肺炎的危险因素进行比较分析;并分析VAP中的病原菌分布及耐药情况。结果 VAP发病与预防使用抗生素、抗生素应用种类、APACHEⅡ评分、机械通气时间、反复气管插管、胃内容物反流均有关(P<0.05);VAP共检出119株致病菌,其中革兰阴性菌87株,革兰阳性菌22株,真菌10株,其中非发酵菌是主要致病菌,耐药率极高,混合感染比例高。结论通过合理使用抗生素、减少机械通气时间、减少反流、减少反复气管插管可减少VAP的发生。VAP病原菌以革兰阴性菌为主,混合感染比例高,应积极防治,根据本地病原学和耐药性分析的指导下合理使用抗生素。
Objective To investigate the risk factors of pathogen-associated pneumonia (VAP) and the distribution and drug resistance of pathogens in intensive care unit (ICU) and provide evidence for clinical prevention and treatment. Methods 186 ICU patients undergoing mechanical ventilation were divided into two groups: VAP group and non-VAP group. The risk factors that may cause ventilator-associated pneumonia were compared and analyzed. The distribution of pathogens in VAP and drug resistance Happening. Results The incidence and prevention of VAP were related to antibiotics, antibiotic application, APACHEⅡscore, mechanical ventilation time, repeated tracheal intubation and reflux of gastric contents (P <0.05). 119 pathogenic bacteria were detected by VAP, 87 strains of negative bacteria, 22 strains of Gram-positive bacteria and 10 strains of fungi. Among them, non-fermentative bacteria are the main pathogenic bacteria with high drug resistance rate and high mixed infection rate. Conclusion The rational use of antibiotics, reduce the mechanical ventilation time, reduce reflux, reduce repeated tracheal intubation can reduce the occurrence of VAP. Gram-negative bacteria are the main pathogens of VAP. The proportion of mixed infections should be high and should be actively controlled. Antibiotics should be rationally used under the guidance of local etiology and drug resistance analysis.