ICU患者下呼吸道菌群与呼吸机相关性肺炎相关性分析

目的 研究ICU患者下呼吸道菌群与呼吸机相关性肺炎（VAP）的相关性。方法 选择2017年1月—2017年12月在新疆医科大学第一附属医院ICU治疗的患者199例。采用自行设计的调查表研究患者基本资料，检测患者血液、痰液、支气管肺泡灌洗液和胸腔积液中病原体分布。结果 ICU患者VAP发病率为34.17%。VAP平卧位患者比例和机械通气时间超过5 d的患者比例明显高于非VAP患者（P=0.000）。VAP患者鲍曼不动杆菌（P=0.000）、肺炎克雷伯杆菌（P=0.000）、铜绿假单胞菌（P=0.000）、阴沟肠杆菌（P=0.039）、金黄色葡萄球菌（P=0.000）、表皮葡萄球菌（P=0.000）、草绿色链球菌（P=0.039）、肠球菌（P=0.039）和白假丝酵母菌（P=0.018）的检测率明显高于非VAP患者。VAP患者发病与病原微生物分布相关：鲍曼不动杆菌（r=0.3274）、肺炎克雷伯杆菌（r=0.3274）、金黄色葡萄球菌（r=0.2975）和白假丝酵母菌（r=0.2371）与VAP发生存在相关性。结论 ICU患者容易发生VAP，病原体以革兰阴性菌为主，其次是革兰阳性菌，第三位是真菌，ICU患者VAP发病率随机械通气时间增加而增加，平卧位患者的VAP发病率更高。

Correlation between inferior respiratory tract flora and ventilator-associated pneumonia in patients in ICUs

Objective To explore the association between inferior respiratory tract flora and ventilator-associated pneumonia in ICU patients．Methods 198 patients admitted in ICUs in our hospital from January 2017 to March 2018 were enrolled．The self-designed questionnaire was used to analyze the basic data of patients；the distribution of pathogens in blood，sputum，bronchoalveolar lavage fluid and pleural effusions were detected．Results The incidence of VAP in ICU patients was 34.17%．The proportions of VAP patients resting in supine position and those with mechanical ventilation longer than 5 days were significantly higher than that of non-VAP patients（P=0.000）．The detection rates of Acinetobacter baumannii（P=0.000），Klebsiella pneumoniae（P=0.000），Pseudomonas aeruginosa（P=0.000），Enterobacter cloacae（P=0.039），Staphylococcus aureus（P=0.000），Staphylococcus epidermidis（P=0.000），Streptococcus viridans（P=0.039），Enterococcus（P=0.039）and Candida albican（P=0.018）in VAP patients were significantly higher than those in non-VAP patients respectively．The incidence of VAP was related with the distribution of pathogens．The results showed that Acinetobacter baumannii（r=0.3274），Klebsiella pneumoniae（r=0.3274），Staphylococcus aureus（r=0.2975）and Candida albicans（r=0.2371）were related with the occurrence of VAP．Conclusion There was high incidence of VAP in ICU patients in our hospital．The pathogens are mainly Gram-negative bacteria，followed by Gram-positive bacteria and then fungi．The incidence of VAP in ICU patients increased with the increase of mechanical ventilation time，especially in patients taking supine position．