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目的探讨先天性心脏病(先心病)术后发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的致病菌分布,分析其耐药性及其变化趋势。方法回顾性分析797例先心病心脏手术患儿的临床资料,对术后发生VAP患儿进行致病菌及耐药性的统计分析。结果 135例患儿术后发生VAP,发生率为16.94%;135例痰标本共检出病原菌289株,包括G-杆菌144株(49.8%),G+球菌87株(30.1%),真菌58株(20.1%);常见G-杆菌为铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希杆菌等;常见G+球菌为凝固酶阴性葡萄球菌、肺炎链球菌、粪肠球菌等;真菌以类酵母菌为主。结论先心病术后VAP的致病菌以G-杆菌为主,致病菌分布有其自身特点;应重视对VAP病原学监测,根据药物敏感试验合理使用抗生素。
Objective To investigate the distribution of pathogens in ventilator-associated pneumonia (VAP) after congenital heart disease (CHD) and analyze their resistance and their changing trend. Methods The clinical data of 797 children with cardiac surgery underwent cardiac surgery were retrospectively analyzed. The pathogenic bacteria and drug resistance of VAP children were analyzed statistically. Results The incidence of postoperative VAP in 135 children was 16.94%. Of the 135 sputum specimens, 289 were pathogenic bacteria including 144 strains of G-bacteria (49.8%), 87 strains of G-bacteria (30.1%) and 58 strains of fungi (20.1%); common G-Bacillus is Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli; common G + cocci coagulase-negative staphylococcus, Streptococcus pneumoniae, Enterococcus faecalis; Yeast-based. Conclusions The pathogens of VAP in patients with congenital heart disease are G-bacilli. The pathogen distribution has its own characteristics. VAP pathogen monitoring should be emphasized, and antibiotics should be used reasonably according to drug sensitivity test.