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目的研究分析呼吸机相关性肺炎（Ｖｅｎｔｉｌａｔｏｒ－ａｓｓｏｃｉａｔｅｄｐｎｅｕｍｏｎｉａＶＡＰ）病原菌的来源、分布特点，探讨ＶＡＰ的发病机制及预防措施。方法将７２例病例分为感染组和对照组，收集两组病例的口咽、鼻部及下呼吸道标本进行细菌定量培养，同时对呼吸机通气回路的湿化器、冷凝器上采集标本作细菌培养，二者同时阳性的菌株进行质粒提取、酶切图谱分析以鉴定其同源性。同时抽取血清比较测量两组的ＳＩｇＡ、ＴＮＦ－α、ＩＬ－８的浓度值。结果ＶＡＰ的发生率为４３．１％，多发生在插管后的３～１２天（平均７．２±２．３天），病原菌主要为Ｇ－菌，占８８．５％，其中铜绿假单胞菌最常见，其次为醋酸钙不动杆菌、阴沟肠杆菌及肺炎克雷伯氏菌，有５例合并真菌感染，呼吸机上采集到的标本中有两例阳性（１株为铜绿假单胞菌，１株为肺炎克雷伯氏菌），经质粒提取、酶切后证实其与患者下呼吸道标本分离出菌株的同源性很高。与对照组相比，感染组患者的ＳＩｇＡ含量明显下降，ＴＮＦ－α及ＩＬ－８的含量却明显上升（Ｐ＜０．０５）。另外，感染组的死亡率为５１．６％，远高于对照组的２１．６％（Ｐ＜０．０５）。结论ＶＡＰ主要是由Ｇ－菌引起，通过其释放的内毒素刺激体内的?
Objective To study the origin and distribution of pathogens of Ventilator-associated pneumonia (VAP) and to explore the pathogenesis and preventive measures of VAP. Methods Seventy-two cases were divided into infection group and control group. The samples of oropharynx, nasal and lower respiratory tract were collected from two groups of patients for bacterial quantitative culture. At the same time, samples were collected from humidifier and condenser of ventilation circuit of ventilator as bacteria Culture, both positive strains were plasmid extraction, enzyme digestion mapping analysis to identify their homology. At the same time, serum concentrations of SIgA, TNF-α and IL-8 in the two groups were compared. Results The incidence of VAP was 43.1%, mostly occurring 3 to 12 days after intubation (average 7.2 ± 2.3 days). The main pathogens were G-bacteria, accounting for 88.5% Amylobacter was the most common, followed by Acinetobacter calcoaceticum, Enterobacter cloacae and Klebsiella pneumoniae. There were 5 cases with fungal infection and two positive samples were collected from the ventilator A strain of Klebsiella pneumoniae), after plasmid extraction, confirmed by digestion with the lower respiratory tract specimens of patients with high homology strains isolated. Compared with the control group, the content of SIgA in the infected group was significantly decreased, while the levels of TNF-α and IL-8 were significantly increased (P <0.05). In addition, the mortality rate in the infected group was 51.6%, much higher than that in the control group (21.6%, P <0.05). Conclusions VAP is mainly caused by G-bacteria, which stimulates the body’s release through endotoxin.