论文部分内容阅读
目的分析急诊重症监护病房呼吸机相关肺炎(ventilator associated pneumonia简称VAP)的致病菌,探讨VAP的发病机制及预防措施。方法对本院急诊重症监护病房行气管插管或气管切开98例患者为对象,分为感染组和对照组,分析VAP患者的临床资料、病原菌构成。同时抽取两组血清,比较TNF-A、IL-2的浓度值。结果 VAP发生率42.86%。革兰阴性杆菌占81.43%,前3位致病菌分别是铜绿假单胞菌(28.57%)、鲍曼不动杆菌(18.57%)和肺炎克雷伯杆菌(15.71%)。细菌耐药率较高。与对照组相比较,感染组患者的死亡率显著高于对照组。与对照组相比,感染组患者的TNF-Α、IL-1的含量明显上升P(<0.05)。结论重症监护病房VAP的致病菌以革兰阴性杆菌为主且呈多重耐药现象,通过内毒素或外毒素刺激细胞免疫系统,分泌致炎细胞因子,同时激活凝血途径,加重病情。
Objective To analyze the pathogens of ventilator associated pneumonia (VAP) in the emergency department of intensive care unit and to explore the pathogenesis and preventive measures of VAP. Methods A total of 98 patients with tracheal intubation or tracheotomy in emergency department of intensive care unit in our hospital were divided into infection group and control group. The clinical data and pathogens of VAP patients were analyzed. At the same time, two groups of serum were taken to compare the concentrations of TNF-A and IL-2. Results The incidence of VAP was 42.86%. Gram-negative bacilli accounted for 81.43%. The first three pathogens were Pseudomonas aeruginosa (28.57%), Acinetobacter baumannii (18.57%) and Klebsiella pneumoniae (15.71%). Bacterial resistance rate is higher. Compared with the control group, the mortality of infected patients was significantly higher than that of the control group. Compared with the control group, the levels of TNF-α and IL-1 in the infected group increased significantly (P <0.05). Conclusion The pathogens of VAP in the intensive care unit are Gram-negative bacilli and are multi-drug resistant. Endotoxin or exotoxin stimulate the cellular immune system, secrete proinflammatory cytokines, and activate the coagulation pathway to aggravate the disease.