【摘要】 目的 了解行机械通气的新型冠状病毒感染患者发生呼吸机相关性肺炎（VAP）的概率、影响因素和感染的病原菌分布。方法 回顾性统计深圳某综合医院2022年10月1日-2023年9月30日收治的733例行机械通气住院患者的临床资料和病原学检查结果，感染新型冠状病毒的患者为Cov组（n=112），非新冠的其他感染患者为n-Cov组（n=621）;Cov合并VAP者为Cov-VAP组（n=37）,n-Cov合并VAP者为n-Cov-VAP组（n=95）。对各组相关临床资料进行分析。结果 Cov组患肾功能不全、慢性肾脏病、冠心病、心力衰竭/心功能不全、呼吸衰竭、贫血等基础疾病的比例分别为23.2%(26/112)、9.8%(11/112)、16.1%(18/112)、19.6%(22/112)、40.2%(45/112)、35.7%(40/112)，显著高于n-Cov组，差异均有统计学意义（χ~2=9.189、4.881、4.357、14.981、63.312、17.630,P均<0.05）。Cov-VAP组中患糖尿病、心力衰竭/心功能不全的比例分别为48.6%(18/37)和24.3%(9/37)，显著高于n-Cov-VAP组，差异均有统计学意义（χ~2=11.843、6.002,P均<0.05）。Cov-VAP组死亡率为43.2%(16/37)，显著高于n-Cov-VAP组22.1%(21/95)，差异有统计学意义（χ~2=5.898,P<0.05）。Cov-VAP组的呼吸道标本共分离出25株病原菌，主要病原菌依次为鲍曼不动杆菌（6株）、铜绿假单胞菌（4株）、肺炎克雷伯菌（4株）、嗜麦芽窄食单胞菌（4株）；n-Cov-VAP组的呼吸道标本共分离出27株病原菌，主要病原菌依次为嗜麦芽窄食单胞菌（9株）、铜绿假单胞菌（7株）、肺炎克雷伯菌（6株），未分离出鲍曼不动杆菌。结论 VAP在行机械通气的新型冠状病毒患者中有较高的发病率和死亡率，高龄、患有肾功能不全、冠心病等基础疾病是高危因素，感染的病原菌主要为革兰阴性菌。更多还原

【Abstract】 Objective To investigate the incidence,risk factors and pathogen spectrum of ventilator-associated pneumonia(VAP) in coronavirus disease 2019(COVID-19) patients undergoing mechanical ventilation(MV).Methods The clinical data and etiological examination results of 733 patients admitted to a general hospital in Shenzhen who were treated with MV from October 1,2022 to September 30,2023 were retrospectively analyzed.Patients eligible for the diagnosis of novel coronavirus were classified as Cov group(n=112),and other patients infected with non-novel coronavirus were classified as n-Cov group(n=621).Cov with VAP is Cov-VAP group(n=37),n-Cov with VAP is n-Cov-VAP group(n=95).Results The proportions of underlying diseases such as renal insufficiency,chronic kidney disease,coronary heart disease,heart failure/cardiac insufficiency,respiratory failure,and anemia in the Cov group were 23.2%(26/112),9.8%(11/112),16.1%(18/112),19.6%(22/112),40.2%(45/112),and 35.7%(40/112),respectively,which were significantly higher than those in n-Cov group,the differences were statistically significant(χ~2=9.189,4.881,4.357,14.981,63.312,17.630,all P<0.05).The proportions of diabetes mellitus and heart failure/cardiac insufficiency among the Cov-VAP group were 48.6%(18/37) and 24.3%(9/37),respectively,which were significantly higher than those of the n-Cov-VAP group,the differences were statistically significant(χ~2=11.843,6.002,all P<0.05).The mortality of the Cov-VAP group(43.2%,16/37)was significantly higher than that of the n-Cov-VAP group(22.1%,21/95),the differences was statistically significant(χ~2=5.898,P<0.05).A total of 25 strains of microorganisms were isolated from respiratory specimens in the COV-VAP group,and the main pathogens were Acinetobacter baumannii(6),Pseudomonas aeruginosa(4),Klebsiella pneumoniae(4),and Stenotrophomonas maltophila(4).Twenty-seven strains of pathogenic bacteria were isolated from respiratory specimens in the non-COVID-19 with VAP group,and the main pathogens were S.maltophila(9),P.aeruginosa(7),and K.pneumoniae(6).A.baumannii was not isolated from the COVID-19 with VAP group.Conclusions A high morbidity and mortality of VAP was seen in patients undergoing MV,and elder age,underlying diseases including renal insufficiency and coronary heart disease were the high-risk factors.Gram-negative bacteria were the commonly identified pathogens.更多还原