Clinical Study On The Sydrome Type Of Chinese Medicine Of Ventilator-Associated Pneumonia

Objective:To explore the clinical risk factors which lead to ventilator-associated pneumonia(VAP) in ICU,the common pathogens and drug resistance in VAP,the percentage of the occurance of the type of Chinese medicine syndrome and the combination situation of the type of Chinese medicine in order to offer the reliable envidence for clinical prevention and treatment of VAP by this research.Methods:(1)Collect the clinical materials of 107 inpatients with more than 48 hours'mechanical ventilation in ICU of a class 3 first level hospital during July 2009 to July 2010,divide them into 2 groups:the VAP group and none-VAP group according to the diagnosis standard and analyze the correlative risk factors of the 2 groups.(2)Count the percentage of the occurance of the type of Chinese medicine syndrome and the combination situation of the type of Chinese medicine.(3)Etiologyic diagnosis was established under quantitative culture of endotraeheal aspiration.All the pathogens were analysised by the full-automatic analyzer made by Philips Co. of USA to get the conclusion of pathogens evaluation and drug-sensitive experiment and analyze the distribution of the pathogens,the condition of drug sensitivity and the treatment and prognosis of VAP.Results:The statistical significances in age and the time of MV of the patients in 2 groups are envident(P<0.05)while it is not envident in primary diseases,gender, the application of H2 receptor blocker usage and prognosis(P>0.05);the main pathogen of VAP is Gram negative bacterium and it takes up 87.05%.The top 3 Gram negative bacterium are Acinetobacter baumannii,Klebsiella pneumonia and Pseudomonasaeurginos with the composition percentage of 37.65%,22.67% and 18.42% separately;in this research,the composition percentage of fungus is more than Gram positive bacterium with the number of 8.5%.The main fungi is Candida albicans. The percentage of the occurance of the type of Chinese medicine syndrome is:the staying of phlegm and wetness in lungs>wind hot attacking lungs>the weakness of lung and kidney>water qi offending heart>wind cold constraining lungs>the weakness of lung and spleen. In the 76 patients with VAP, there are 3 single syndrome type with the percentage of 3.95%,25 two syndromes type combination with the percentage of 32.89%,36 three syndromes type combination with the percentage of 47.37%,17 four syndrome type combination with the percentage of 22.37%and 1 five syndrome type combination with the percentage of 1.32%.Conclusions:(1)The occurance of VAP is related to many factors and the main risk factors are advanced age and long time of MV.(2)In the differentiation type of Chinese medicine of VAP,the staying of phlegm and wetness in lungs and wind hot attacking lungs are common in excessive syndrome while the weakness of lung and kidney are common in weak syndrome.The clinical syndrome type is not single with the common syndrome combination of 2 or 3.(3)The main pathogen of VAP is Gram negative bacterium.Multiple drug resistance exsits and some pathogens are resistant to the high level antibiotics.And fungus also take certain percentage the patients with VAP.