标题:肿瘤患者呼吸机相关性肺炎的危险因素及病原学分析
作者:余昌平
(武汉大学人民医院呼吸内科,湖北 武汉 430060)
卷次:
2012年23卷15期
【摘要】 目的 探讨肿瘤患者呼吸机相关性肺炎(VAP)的危险因素以及其病原学特点。方法 对我院收治
的427例接受呼吸机治疗的肿瘤患者进行研究,对呼吸机相关性肺炎的危险因素进行分析,并对其病原学以及耐
药情况进行分析。结果 本组患者中有163例发生VAP。器械通气时间、使用质子泵抑制剂以及骨髓抑制情况、
APACHEⅡ评分、CLIS评分是导致肿瘤患者VAP发生的独立危险因素;病原菌主要以革兰阴性菌为主,占62.2%,
其中铜绿假单胞菌、嗜麦芽黄单胞菌、鲍曼不动杆菌、大肠埃希氏菌以及肺炎克雷伯菌为主要条件致病菌;其次为
革兰阳性菌(21.2%)以及真菌(15.6%)。哌拉西林/他唑巴坦以及美洛培南对嗜麦芽寡养单胞菌、鲍曼不动杆菌、铜
绿假单胞菌、大肠埃希菌、肺炎克雷伯杆菌有良好的敏感性。结论 积极对原发病进行治疗,降低通气时间并积极
对骨髓抑制进行纠正,可有效减少患者VAP的发生率,同时头孢哌酮/舒巴坦是VAP的经验治疗的首选。
【关键词】 呼吸机相关性肺炎;肿瘤;病原学;危险因素
【中图分类号】 R563.1 【文献标识码】 B 【文章编号】 1003—6350(2012)15—094—03<
br>Analysis of risk factors and etiology of cancer patients with ventilator-associated pneumonia.
YU Chang-ping.
Department of Respiratory Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, CHINA
【Abstract】 Objective To investigate the risk factors of cancer patients with ventilator-associated pneumonia
(VAP), as well as their pathogenic characteristics. Methods Four hundred and twenty-seven cancer patients in our
hospital receiving ventilator therapy were studied. The risk factors of VAP, etiology and drug resistance were ana-
lyzed. Results 163 of the 427 patients were complicated with VAP. Mechanical ventilation time, use of proton pump
inhibitors as well as bone marrow suppression, APACHE Ⅱ score, the CLIS score were found to be the independent
risk factors of VAP in for cancer patients. The pathogens were mainly gram-negative bacteria (62.2%), including Pseu-
domonas aeruginosa Aeromonas, Xanthomonas maltophilia, Acinetobacter baumannii, Escherichia coli and Klebsiella
pneumoniae as the opportunistic pathogen, followed by gram-positive bacteria (21.2%) and fungi (15.6%). Piperacillin/
Tazobactam and meropenem were found to with good sensitivity to Stenotrophomonas maltophilia, Acinetobacter bau-
mannii, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniaehas. Conclusion The positive treatment of
primary diseases and the reduction of ventilation time as well as the active correction of bone marrow suppression can
effectively reduce the incidence of VAP. And the cefoperazone/sulbactam is the first choice for the empirical treatment
of VAP.
【Key words】 Ventilator-associated pneumonia; Tumor; Etiology; Risk factors
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