先天性心脏病体外循环术后呼吸机相关性肺炎的研究

摘要

OBJECTIVE To investigate the distribution and the drug resistance of pathogens in children with ventilator - associated pneumonia ( VAP ) after cardiopulmonary bypass ( CPB ) in recent two years.METHODS 322 cases with VAP after CPB in pediatric cardiac center of Fuwai hospital were studied and analyzed retrospectively.The pathogens of the sputum draw from the lower tract were identified by Vitek32 and were analyzed by whonet 5.4.RESULTS With the CPB time prolonged, the incidence of VAP was higher ( P ＜ 0.01 ).A total of 396 pathogen strains were isolated by bacterial culture.The main pathogenic bacteria in VAP were the gram - negative bacilli accounting for 282 strains ( 71.2％ ), the gram - positive bacteria accounting for 51 strains ( 12.9％ ), and fungi accounting for 63 strains ( 15.9％ ).The main Gram -negative bacilli were K.pneumoniae, P.aeruginosa, E.coli, and et al.The main Gram - positive bacteria were coagulase negative staphylococcus, enterococcus faecalis and staphylococcus aureus.The main fungi was Candida.CONCLUSION To research the pathogens and their antibiotic resistance patterns in VAP children after CPB will be very important for clinical treatment.%目的 研究儿童先天性心脏病(先心病)体外循环(CPB)术后发生呼吸机相关性肺炎(VAP)的病原菌分布,分析其耐药性及变化趋势.方法 回顾分析2009年1月至2010年12月阜外心血管病医院小儿心脏中心4 300例行CPB手术的患儿资料,对发生VAP的患儿进行致病菌及耐药性的统计分析.结果 322例患儿在CPB术后发生VAP,发生率7.49%.随CPB时间延长,VAP的发生率增高,有显著性差异(各组间比较P<0.01).322例患儿痰标本中共检出病原菌396株,包括革兰阴性杆菌282株(71.2%)、革兰阳性球菌51株(12.9%)、真菌63株(15.9%).常见革兰阴性杆菌为肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希杆菌、鲍曼不动杆菌等;常见革兰阳性球菌为凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌、金黄色葡萄球菌;真菌以白色念珠菌为主. 结论 先心病CPB术后VAP的致病菌分布有其自身特点.CPB时间延长可能会增加术后VAP的发生率.综合的防控措施并合理使用抗生素,是VAP预防和治疗的重点.