重症监护病房患者气管切开术后肺部感染68例临床分析

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1、重症监护病房患者气管切开术后肺部感染68例临床分析作者：张宝民，孙艳，张志萍，徐继来，潘利平【摘要】目的探讨重症监护病房（ICU）患者气管切开后肺部感染病原菌的类型及其耐药性，为临床经验性用药提供帮助。方法回顾性分析ICU68例气管切开术后并发肺部感染患者的痰细菌培养及药物敏感性测定结果。结果共分离出97株致病菌，其中革兰阴性杆菌（GNB）占67.01%，革兰阳性球菌（GPC）占27.84%，真菌占5.15%。铜绿假单胞菌居首位，分离出产超广谱β-内酰胺酶（ESBLs）菌6株，耐甲氧西林金黄色葡萄球菌（MRSA）5株。所分离致病菌对

2、常用抗菌药物均有不同程度的耐药，且为多重耐药。气管切开患者肺部感染与基础疾病、使用呼吸机、昏迷、不合理应用抗菌药物密切相关。结论ICU气管切开患者肺部感染是多因素相互作用的结果，致病菌以GNB为主，临床应重视病原菌的检查及耐药性的监测，合理选用抗菌药物。【关键词】肺部感染气管切开病原菌重症监护病房Abstract:ObjectiveToinvestigatethedistributionanddrugresistanceofpathogenfromICUpatientswithlunginfectionsfollowingtrach

3、ealincision.Methods68in-patientswerecomplicatedwithlunginfectionsfollowingtrachealincisionsandaretrospectiveanalysisofthecultured9pathogenicmicroorganismsfromthesputumandtheirsusceptibilitytodrugswasthusperformed.Qualifiedsputumspecimenswereculturedforbacterialisolatio

4、n，andtheanti-microbialactivitytestsweredetermined.ResultsTotally97strainsofpathogenswereisolatedbybacterialculture,ofwhichtheGram-negativebacilli（GNB）isolatedwas67.01%inproportion,theGram-positivecocci(GPC)was27.84%andthefungiwas5.15%,respectively.AmongthemthePseudomon

5、asaeruginosacontributedtothemajority,thoseproducingtheextended-spectrumβ-lactamases(ESBLs)accountedfor6strains,andmethicillin-resistantstaphylococcusaureus（MRSA）contributedto5strains.Theywereresistanttocommonantibioticsandparticularlyresistanttoamultitudeofantibiotics.

6、Lowerrespiratoryinfectionsfollowingtrachealincisionwerecloselycorrelatedwithbasicdiseases,useofventilator,durationofcomaandabuseofantibiotics.ConclusionsThelunginfectionsinpatientswithtrachealincisioninICUwerecausedbytheinteractionsofmultiplefactors.Themajorpathogenicm

7、icroorganismsareGNB.Itisadvisablethatemphasisbelaidonthesurveillanceofbacterialresistanceandrationaluseofantimicrobialagentsinclinicaltherapy.9Keywords：lunginfections;trachealincision;pathogenicmicroorganism;intensivecareunit重症监护病房（ICU）收治的患者病情均较危重，气管切开常作为抢救患者生命的一种重要的应急

8、抢救措施。但气管切开后，气道与外界直接相通，破坏了呼吸道正常的防御功能，且反复的吸痰以及机械通气更增加了肺部感染的机会。了解ICU肺部感染细菌的流行及变迁的规律，为危重病患者抗感染经验治疗提供依据十分必要。本文回顾性分析连云港市第一人