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目的探索在呼吸重症监护病房(RICU)内医院获得性肺炎(HAP)的危险因素与病原菌的分布情况。方法对85例接受呼吸机治疗的RICU内的患者,评估主要病因、合并症和并发症,监测内环境紊乱、RICU居住时间以及辅助呼吸类型,以及发生HAP的例数,细菌学监测结果。结果单因素分析,在RICU内的滞留时间和使用有创辅助通气是发生HAP的危险因素(P<0.05),多因素分析,使用有创辅助通气是发生HAP的危险因素(OR=18.581,P<0.05)。RICU内HAP的病原菌以革兰阴性菌为主(72%),以天然耐药菌为主。结论有创辅助呼吸和RICU居住时间是RICU内患者发生HAP的危险因素;RICU中HAP的病原菌以革兰阴性菌多见,而且多数对常用抗感染药物具有天然耐药的特性。
Objective To explore the risk factors of hospital acquired pneumonia (HAP) and the distribution of pathogens in respiratory intensive care unit (RICU). Methods Eighty-five patients undergoing ventilator-treated RICU were enrolled in this study to assess the major causes, comorbidities and complications, monitoring of internal environmental disturbances, duration of RICU, and types of assisted breathing as well as the number of HAP cases and bacteriological surveillance. Results Univariate analysis showed that residence time in patients with RICU and invasive assisted ventilation were risk factors for developing HAP (P <0.05). Multivariate analysis showed that invasive assisted ventilation was a risk factor for HAP (OR = 18.581, P <0.05). The pathogens of HAP in RICU are mainly Gram-negative bacteria (72%), mainly natural resistant bacteria. Conclusions The invasive assisted breathing (RIA) and residence time of RICU are the risk factors of HAP in patients with RICU. The pathogenic bacteria of HAP in RICU are more common with gram-negative bacteria, and most of them are naturally resistant to common anti-infective drugs.