摘要
目的探讨重症监护病房人工气道患者发生下呼吸道感染的病原菌分布及影响因素分析。方法选取2014年3月-2016年3月于重症监护病房行人工气道的96例患者,对人工气道采集的痰标本进行细菌培养、分离及鉴定,分析病原菌特点,统计分析患者插管类型、插管留置时间、APACHEⅡ评分、机械通气、声门下分泌物等资料进行单因素分析,根据单因素分析结果进行多因素Logistic分析。结果 96例重症监护病房行人工气道的患者中,有39例发生下呼吸道感染,感染发生率为40.6%;39例下呼吸道感染患者中共培养出病原菌103株,其中革兰阳性菌20株占19.4%、革兰阴性菌71株占68.9%、真菌12株占11.7%;多因素Logistic回归分析结果显示,经气管插管后气管切开、插管留置时间>7天、使用机械通气、APACHEⅡ评分>17分、未采用声门下分泌物吸引及口腔护理<3次/天是人工气道患者发生下呼吸道感染的影响因素。结论重症监护病房患者行人工气道后导致下呼吸道感染的病原菌以革兰阴性菌为主;插管留置时间、插管类型、是否机械通气等多种因素都与人工气道下呼吸道感染密切相关,需采取有效的干预措施以减少感染的发生。
OBJECTIVE To investigate the distribution of pathogenic bacteria and influencing factors of lower respiratory tract infections in artificial airway patients in intensive care unit.METHODS A total of 96 patients with artificial airway from Mar.2014 to Mar.2016 were enrolled in the intensive care unit of our hospital.The sputum specimens were taken from the disposable sterilization suction tube by artificial airway for bacterial culture,isolation and identification.The characteristics of pathogens were analyzed,and the data of intubation type,intubation time,APACHE II score,mechanical ventilation and subglottic secretion were statistically analyzed for univariate analysis,and multivariable logistic analysis was performed based on the univariate analysis.RESULTS All patients with lower respiratory tract infections in 39 cases,and the infection rate was 40.6%.A total of 103 strains of pathogenic bacteria were cultured,of which 20（19.4%）strains were gram-positive bacteria,71（68.9%）strains were gram-negative bacteria and 12（11.7%）strains were fungi.Multivariable logistic analysis showed that tracheotomy after tracheal intubation,intubation time more than 7 days,the use of mechanical ventilation,APACHE Ⅱ score greater than 17 points,and oral care after artificial airway intubation3 times per day were influencing factors of lower respiratory tract infections in patients with artificial airway.CONCLUSIONThe pathogenic bacteria of lower respiratory tract infections caused by artificial airway in patients in intensive care unit are mainly gram-negative bacteria.Many factors,such as intubations time,intubation type and mechanical ventilation,are closely related to artificial airway lower respiratory tract infections,and effective interventions should be taken to reduce the incidence of infections.
作者
濮怡
赵志
王艳
钱晨莹
王秋艳
PU Yi;ZHAO Zhi;WANG Yan;QIAN Chen-ying;WANG Qiu-yan(The First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu 215000, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第7期991-993,1019,共4页
Chinese Journal of Nosocomiology
基金
国家科技重大专项基金资助项目(2012ZX10002004)
关键词
人工气道
下呼吸道感染
病原菌
影响因素
Artificial airway
Lower respiratory tract infection
Pathogen
Influencing factors
