85例危重症患者吸入性肺炎的高危因素及病原菌分析

赵志海++朱涛

DOI：10.16662/j.cnki.1674-0742.2017.23.041

[摘要] 目的 探讨危重患者吸入性肺炎的临床特点，为其预防和治疗提供依据。方法 回顾性分析自2011年4月—2014年9月入住该院ICU的1 323例患者的临床资料。 结果 吸入性肺炎患者以发热、咳嗽等临床表现为主，高危因素为意识障碍，鼻饲，机械通气等。共取得病原菌200株，其中革兰氏阴性菌84.5%，革兰氏阳性菌9.5%，真菌6.0%；病原菌中前4位为铜绿假单胞菌，鲍曼不动杆菌，肺炎克雷白杆菌，嗜麦芽窄食单胞菌。结论 重症患者吸入性肺炎的发生与高危因素有关，吸入性肺炎的病原菌以革兰氏阴性杆菌为主。

[关键词] 吸入性肺炎；危重患者；高危因素；病原菌

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2017）08（b）-0041-03

Analysis of Risk Factors and Pathogens of Inhaled Pneumonia in 85 Critical Patients

ZHAO Zhi-hai， ZHU Tao

Department of Emergency， Taicang No.1 Peoples Hospital， Taicang， Jiangsu Province， 215400 China

[Abstracts] Objective This paper tries to analyze the clinical features of aspiration pneumonia of critical patients and to provide guidance for prevention and treatment of the aspiration pneumonia. Methods 1 323 cases received in ICU of this hospital from April 2011 to September 2014 were retrospectively analyzed. Results Inhaled pneumonia patients had fever， cough and other clinical manifestations； the high risk factors included disturbance of consciousness， nasal feeding， and mechanical ventilation and so on. A total of 200 strains of pathogens were obtained， among which Gram-negative bacteria was 84.5%， Gram-positive bacteria were 9.5% and fungi were 6.0%. The top four pathogens were Pseudomonas aeruginosa， Acinetobacter baumannii， Klebsiella pneumoniae Stenotrophomonas maltophilia. Conclusion The incidence of inhaled pneumonia in critically ill patients is associated with risk factors， and the pathogenic bacteria of inhaled pneumonia are mainly Gram-negative bacilli.

[Key words] Aspiration pneumonia； Critically ill patients； High risk factors； Pathogenic bacteria

吸入性肺炎是指吸入食物、口咽分泌物、胃內容物及其他液体或固体物质引起的肺部化学性或合并细菌性炎症，其严重程度与胃液中盐酸浓度、吸入量以及在肺内的分布情况有关。该病好发于老年人，且有研究指出，约60.1%的社区获得性肺炎和86.7%的医院获得性肺炎均为吸入性肺炎。为了分析危重症吸入性肺炎患者的高危因素及病原菌的特点，以为临床预防和治疗提供依据，该研究对2011年4月—2014年9月入住该院ICU的1 323例患者的临床资料进行了回顾性分析，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析入住该院ICU的1 323例患者。其中85例诊断为吸入性肺炎，所有患者均为成年人，其中男68例，女17例，≥65岁为61例，平均年龄为（71.1±14.8）岁，平均住院天数为（21.5±22.0）d。

1.2 吸入性肺炎诊断标准

患者有误吸史，有吸入性肺炎的……