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目的 研究外科重症监护室(SICU)患者机械通气相关性肺炎(VAP)发病与影响预后的危险因素,并了解VAP的病原体分布及细菌耐药性变化。方法 1994年1月～1996年12月3a期间本院SICU收治60例VAP为感染组,同期机械通气未产生VAP的24例为对照组。采用SAS统计软件包分别就影响VAP发病和预后的11项和10项可能因素进行单因素、多因素逐步Logistic回归分析。细菌的耐药性测定采用微量药敏稀释法。结果 (1)单变量分析显示胃管留置、H2受体阻断剂、利尿剂、糖皮质激素、多种抗生素、呼气末正压(PEEP)、重复气管插管、插管时间延长均与VAP发病有关。(2)多元逐步Logistic回归分析示多种抗生素应用、气管插管时间延长、重复气管插管、H2受体阻断剂具有显著意义(P<0.01)。(3)单因素分析示胸腹部联合手术、休克、肾功能减退、菌血症与VAP预后相关,而多元回归分析仅有胸腹部联合手术、菌血症在影响VAP预后方面具有显著意义(P<0.01)。(4)革兰阳性细菌占24.3%(23株),革兰阴性杆菌(GNB)占73.9%(71株),其中肠杆菌科细菌仅占23.8%,非发酵菌占50.1%,真菌占2.1%(2株)。(5)药敏测试结果示GNB对12种抗生素有不同程度耐药,尤其绿脓杆菌、其他假单胞菌、不动杆菌等非发酵菌的耐药率更高。结论 多种抗生素应用、气管插管时间延长、重
Objective To study the risk factors of pathogenesis of mechanical ventilation-related pneumonia (VAP) in patients with surgical intensive care unit (SICU) and prognosis, and to understand the distribution of pathogens and the change of bacterial resistance in VAP. Methods Between January 1994 and December 1996, 60 cases of VAP in SICU were treated in our hospital. 24 cases of VAP without mechanical ventilation during the same period were selected as control group. Using SAS statistical software package, 11 and 10 possible factors affecting the incidence and prognosis of VAP were analyzed by single factor and multi-factor stepwise logistic regression respectively. Bacterial drug resistance assay using micropipette-sensitive dilution method. Results (1) Univariate analysis showed that gastric tube indwelling, H2 receptor blockers, diuretics, glucocorticoids, multiple antibiotics, positive end expiratory pressure (PEEP), repeated tracheal intubation, VAP related to the disease. (2) Multivariate stepwise Logistic regression analysis showed that the use of multiple antibiotics, prolonged tracheal intubation, repeated tracheal intubation, and H2 receptor blockers had significant significance (P <0.01). (3) Univariate analysis showed that thorax and abdomen combined surgery, shock, renal dysfunction, bacteremia and VAP prognosis related, and multiple regression analysis only thoracoabdominal surgery, bacteremia in the prognosis of VAP has significant (P <0.01). (4) Gram-positive bacteria accounted for 24.3% (23 strains), Gram-negative bacteria (GNB) accounted for 73.9% (71 strains), of which Enterobacteriaceae accounted for only 23.8%, non-fermentative bacteria accounted for 50.1% and fungi accounted for 2.1 % (2 strains). (5) The result of drug susceptibility test showed that GNB has resistance to 12 kinds of antibiotics, especially non-fermenting bacteria such as Pseudomonas aeruginosa, other Pseudomonas and Acinetobacter. Conclusion A variety of antibiotics, intubation time, weight