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目的了解新生儿呼吸机相关性肺炎(VAP)的临床特点。方法回顾性分析我院新生儿重症监护病房2004年1月至2006年10月机械通气≥48h的102例患儿临床资料。结果并发VAP53例,占51.9%,诊断时间平均在机械通气后90.3(±22.5)h,临床表现以胸片浸润阴影(100%)、呼吸道内出现脓性分泌物(88.7%)、肺部湿罗音(77.4%)及PCO2>45mmHg(64.2%)为主。发热28例(52.8%),白细胞增多12例(22.6%),51例痰培养阳性(96.2%),其中革兰阳性球菌占53.8%,革兰阴性杆菌占46.2%。肺炎克雷伯菌、溶血葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌、大肠埃希菌、阴沟肠杆菌是6种主要致病菌,耐药率高。放弃治疗及死亡12例,占22.6%。结论VAP病原复杂、易变,应严格掌握抗生素的适应症,避免过多使用抗生素,防止耐药菌株的出现。
Objective To understand the clinical features of neonatal ventilator-associated pneumonia (VAP). Methods A retrospective analysis of our hospital neonatal intensive care unit from January 2004 to October 2006 mechanical ventilation ≥ 102h clinical data of 102 children. Results Fifty-three cases were complicated by VAP, accounting for 51.9%. The average time of diagnosis was 90.3 (± 22.5) h after mechanical ventilation. The clinical manifestations were chest radiography (100%), purulent discharge in the respiratory tract (88.7%), Luo Yin (77.4%) and PCO2> 45mmHg (64.2%) based. Fever was found in 28 (52.8%), leukocytosis in 12 (22.6%), and sputum culture in 51 (96.2%), of which Gram-positive cocci accounted for 53.8% and gram-negative bacilli accounted for 46.2%. Klebsiella pneumoniae, Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Enterobacter cloacae are the six main pathogens, high resistance rate. Give up treatment and death in 12 cases, accounting for 22.6%. Conclusions VAP pathogens are complex and variable. The indications of antibiotics should be strictly controlled to avoid excessive use of antibiotics to prevent the emergence of drug-resistant strains.