CAJ | 학술논문

目的：通过对有创机械通气时间超过48h患者的临床资料进行回顾性分析，比较早发性和晚发性VAP相关危险因素、发生率、病死率以及病原菌流行病学特点，为防治VAP提供科学依据。方法回顾性分析2008年5月～2011年9月间在我院ICU科住院治疗的183例VAP患者的临床资料，将VAP患者分为早发性VAP（EOP）组和晚发性VAP（LOP）组。观察比较两组患者相关危险因素；对两组患者的微生物学资料进行调查。结果EOP和LOP的发生率分别为26.78%和73.22%，病死率分别为20.41%和41.04%。GCS评分6～9分时LOP多见，在10～14分时EOP多见。住院时间＜7d时间段内EOP患者多于LOP患者；住院时间＞14d时间段LOP患者多于EOP患者（P＜0.05）。G-菌的构成比在LOP组及EOP组中均占优势。嗜麦芽寡养单胞菌多见于LOP，肺炎克雷伯氏菌多见于EOP。≥2种病原菌混合感染及合并真菌感染LOP患者多于EOP患者（P＜0.05）。结论尽量避免VAP相关危险因素，早期诊断、早期治疗，对降低VAP的发病率和病死率具有重要意义。
목적：통과대유창궤계통기시간초과48h환자적림상자료진행회고성분석，비교조발성화만발성VAP상관위험인소、발생솔、병사솔이급병원균류행병학특점，위방치VAP제공과학의거。방법회고성분석2008년5월～2011년9월간재아원ICU과주원치료적183례VAP환자적림상자료，장VAP환자분위조발성VAP（EOP）조화만발성VAP（LOP）조。관찰비교량조환자상관위험인소；대량조환자적미생물학자료진행조사。결과EOP화LOP적발생솔분별위26.78%화73.22%，병사솔분별위20.41%화41.04%。GCS평분6～9분시LOP다견，재10～14분시EOP다견。주원시간＜7d시간단내EOP환자다우LOP환자；주원시간＞14d시간단LOP환자다우EOP환자（P＜0.05）。G-균적구성비재LOP조급EOP조중균점우세。기맥아과양단포균다견우LOP，폐염극뢰백씨균다견우EOP。≥2충병원균혼합감염급합병진균감염LOP환자다우EOP환자（P＜0.05）。결론진량피면VAP상관위험인소，조기진단、조기치료，대강저VAP적발병솔화병사솔구유중요의의。
Objective To retrospectively analyze clinical data of patient in invasive mechanical ventilation more than 48 hours and compared early-onset and late-onset VAP-related risk factors, incidence, mortality and epidemiological characteristics of pathogens, to provide scientific basis for combating VAP. Methods A clinical data of 183 cases of patients with VAP treated in ICU department our hospital from May 2008 to September 2011 was retrospective analyzed and divided into early-onset VAP (EOP) and late-onset VAP group (LOP) group. Two groups of patients with associated risk factors were observed and compard; and both groups of patients microbiology data were investigated. Results Incidence of EOP and LOP were 26.78%and 73.22%,respectively, mortality were 20.41%and 41.04%. LOP was more common with GCS score 6-9, shared EOP common with GOS score 10 to 14. less than 7 days period in hospitalization EOP was more than LOP in patients;longer than 14 days time period in hospitalization LOP was more than EOP in patients (P < 0.05). Constituent ratio of G- bacteria was competitive in both LOP and EOP group. Stenotrophomonas maltophilia was prevalent in the LOP, Klebsiella pneumoniae was prevalent in the EOP. LOP with more than 2 kinds of mixed infection and fungal infection was more than EOP (P<0.05). Conclusion To avoid VAP-related risk factors, early diagnosis, early treatment, to reduce the incidence and mortality of VAP will be great of significance.