| 吕培瑾,李书阅,蒋云书,等.慢性阻塞性肺疾病急性加重期 318例的呼吸机相关性肺炎预测指标和微生物学特征分析[J].安徽医药,2022,26(4):770-773. |
| 慢性阻塞性肺疾病急性加重期 318例的呼吸机相关性肺炎预测指标和微生物学特征分析 |
| Predictors and microbiological characteristics of ventilator-associated pneumonia in patients with chronic obstructive pulmonary disease |
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| DOI：10.3969/j.issn.1009-6469.2022.04.029 |
| 中文关键词: 肺疾病，慢性阻塞性 肺炎，呼吸机相关性 鲍氏不动杆菌 肺炎克雷伯菌 预测因子 |
| 英文关键词: Pulmonary disease, chronic obstructive Pneumonia, ventilator-associated Acinetobacter baumannii Klebsiella pneumoniae Predictor |
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| 中文摘要: |
| 目的探讨慢性阻塞性肺疾病( COPD)急性加重期呼吸机相关性肺炎( VAP)的预测指标和微生物学特征。方法以 2016年 12月至 2019年 12月聊城市第二人民医院呼吸内科收治的 COPD急性加重期 318例为研究对象，根据是否发生 VAP分为 VAP组和非 VAP组。记录病人基线人口统计学信息及临床特征。采用多因素 logistic回归分析 COPD急性加重期 VAP的预测因素。通过革兰染色涂片及镜检，并对标本进行培养及药敏试验来进行微生物学诊断。结果 COPD持续时间、住院前恶化持续时间、 APACHE-2评分、入院时 SOFA评分 VAP病人分别为 10.38(8.50，12.27)年、(8.65±2.69)d、(21.24±2.57)分、(7.55± |
| 英文摘要: |
| Objective To investigate the predictors and microbiological characteristics of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 318 patients with exacerbation of COPD who were ad mitted to the Department of Respiratory Medicine, Liaocheng Second People's Hospital from December 2016 to December 2019 were se lected as the research subjects. They were assigned into VAP group and non-VAP group according to whether VAP occurred. Baselinedemographic information and clinical characteristics of patients were recorded. Multivariate Logistic regression was used to analyze thepredictors of VAP in patients with COPD exacerbation. Microbiology diagnosis was performed by Gram stain smear and microscopy, andculture and drug sensitivity tests were performed on the specimens.Results The duration of COPD, the duration of deterioration before hospitalization, apache-2 score, SOFA score at admission, VAP patients were 10.38 (8.50, 12.27) years, (8.65±2.69) days, (21.24±2.57)points and (7.55±2.33) points respectively, and non VAP patients were 3.90 (2.40, 8.40) years, (5.22±2.16) days, (16.26±2.46) pointsand (4.34±1.50) points respectively. There was significant difference between the two groups (P<0.01). Compared with non-VAP pa tients, the proportion of multiple hospitalizations due to COPD, history of tuberculosis, diabetes, re-intubation after admission, use of va sopressors during admission, antibiotics used in the past 90 days in VAP patients were increased significantly (P<0.05). Multivariate Lo gistic regression analysis showed multiple hospitalizations due to COPD, diabetes, APACHE-2 score, SOFA score at admission, reintuba tion after admission, and antibiotic use in the past 90 days were important predictors of VAP in patients with COPD exacerbation (ORvalues were 67.128, 12.996, 2.352, 2.054, 7.253 and 3.546 respectively). Gram-negative bacteria were present in 57 (100%) VAP pa tients with bronchoalveolar lavage (BAL) or intratracheal aspiration (ETA) specimens. Acinetobacter baumannii was the most commonmicroorganism (n=27, 47.3%), followed by Klebsiella pneumoniae (n=18, 31.6%), Pseudomonas aeruginosa (n=3, 5.3%), and Enterobac ter (n=3, 5.3%). All pathogens were multidrug-resistant.Conclusion Multiple hospitalizations due to COPD, diabetes, APACHE-2 score, SOFA score at admission, reintubation after admission, and antibiotic use in the past 90 days were independent predictors ofVAP in patients with COPD exacerbation. Antimicrobial treatment of VAP should cover multi-drug resistant Gram-negative bacteria. |
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