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目的探讨老年肺结核患者呼吸机相关性肺炎(VAP)的病原菌特点及危险因素,为临床预防VAP提供参考。方法回顾性分析2007年6月-2014年2月医院收治的176例接受机械通气肺结核患者临床资料,对老年肺结核患者并发VAP的病原菌分布、耐药性特点及危险因素进行总结分析,采用单因素及多因素logistic回归方法进行统计分析。结果 176例接受机械通气肺结核患者发生VAP 75例,发生率为42.6%,筛选出年龄>70岁、病程>5年、病灶范围>4个肺野、空洞数量>4个、结核菌素试验阴性、复治患者、有合并症、机械通气时间>7d与老年肺结核患者发生VAP呈正相关;发生VAP老年肺结核患者分离出120株病原菌,其中革兰阴性菌占71.7%,真菌占18.3%,革兰阳性菌占10.0%;主要革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南及氨曲南等耐药率均≥50.0%。结论老年肺结核患者发生VAP的独立危险因素多,VAP主要的病原菌以革兰阴性菌及真菌为主,混合感染发生率高,且耐药性较高。
Objective To investigate the characteristics and risk factors of pathogens in ventilator-associated pneumonia (VAP) in elderly patients with pulmonary tuberculosis and provide a reference for the prevention of VAP. Methods The clinical data of 176 cases receiving mechanical ventilation pulmonary tuberculosis from June 2007 to February 2014 were retrospectively analyzed. The distribution of pathogens, drug resistance characteristics and risk factors of VAP in elderly patients with pulmonary tuberculosis were analyzed. Single factor And multivariate logistic regression method for statistical analysis. Results A total of 176 patients with mechanical ventilation pulmonary tuberculosis (VAP) developed 75 cases of VAP, with a incidence rate of 42.6%. The patients were over 70 years of age with a history of> 5 years. , Retreatment patients, with complications, mechanical ventilation time> 7d with VAP in elderly patients with pulmonary tuberculosis was positive; VAP senile pulmonary tuberculosis patients isolated 120 strains of pathogens, of which Gram-negative bacteria accounted for 71.7%, fungi accounted for 18.3%, Gram Positive bacteria accounted for 10.0%; the main Gram-negative bacteria cefoperazone / sulbactam, imipenem, meropenem and aztreonam resistance rates were ≥ 50.0%. Conclusion There are many independent risk factors for VAP in elderly patients with pulmonary tuberculosis. The main pathogens of VAP are gram-negative bacteria and fungi. The incidence of mixed infection is high and the drug resistance is high.