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中文摘要: 目的 对感染革兰阴性杆菌的重症肺炎患者进行多重耐药性分析，探讨重症肺炎患者的危险因素和预后。方法 对大连市中医医院2013年3月—2014年7月期间确诊重症肺炎的126名患者进行细菌培养分析并纳入革兰阴性杆菌感染的重症肺炎患者40例，根据是否多重耐药将其分为多重耐药组和非多重耐药组，对两组患者住院期间的理化指标、急性生理学和慢性健康评分（APACHE-II）、住院时间及死亡率进行对比分析。结果 126例重症肺炎患者共分离细菌182株，其中革兰阴性菌129株，革兰阳性菌53株。抗生素耐药结果显示5种主要的革兰阴性菌对庆大霉素的耐药率均较高，鲍曼不动杆菌对常用的抗生素耐药明显，大肠埃希杆菌对环丙沙星耐药率较高，嗜麦芽寡养单胞菌对美洛培南完全耐药，同时对头孢噻肟、亚胺培南、阿米卡星和哌拉西林均有较高的耐药率。多重耐药组22例患者分离出多重耐药革兰阴性杆菌33株,分别为鲍曼不动杆菌11株(33.3%)、铜绿假单胞菌8株(24.2%)、肺炎克雷伯杆菌7株(21.2%)、大肠埃希杆菌5株(15.2%)和嗜麦芽窄假单胞菌2株(6.1%)。多重耐药组患者的APACHE-Ⅱ评分、住院时间以及死亡率方面均明显高于非多重耐药组（p＜0.05）。两组患者理化检查指标除血清白蛋白多重耐药组明显低于非多重耐药组外（P＜0.05），其余指标差异均无无统计学意义（P＞0.05）。结论 多重耐药革兰阴性杆菌重症肺炎患者病死率明显升高, 在临床治疗上要综合分析多种因素，加强对革兰阴性杆菌的药敏检测，合理选择抗生素，改善患者预后。
Abstract:OBJECTIVE To explore the risk factors and prognosis of severe pneumonia patients with severe pneumonia by multiple drug resistance analysis. METHODS in our hospital in March 2013 to July 2014 diagnosed during a severe pneumonia of the 126 patients for analysis of bacterial culture and incorporated into the leather gram negative bacillus infection in patients with severe pneumonia in 40 cases, according to multi - drug resistance will be divided into multiple resistant group and non multiple resistant group of two groups of patients hospitalized during the physicochemical indexes, acute physiology science and chronic health evaluation (APACHE), hospitalization time and mortality were compared and analyzed. RESULTS a total of 126 patients with severe pneumonia were isolated from 182 strains of bacteria, including 129 gram negative bacteria, 53 gram positive bacteria. Antibiotic resistance results show that five main leather gram negative bacteria resistant to gentamicin was significantly higher in Acinetobacter baumannii coli marked for antibiotics commonly used and Escherichia coli resistant to ciprofloxacin rate is higher, Stenotrophomonas maltophilia to meropenem resistant, resistant to cefotaxime, imipenem, amikacin and piperacillin were higher rate at the same time. Multidrug resistance group (22 cases) isolated from patients with multi drug resistance of 33 strains of gram negative bacilli, respectively, Bauman Acinetobacter 11 strains (33.3%), Pseudomonas aeruginosa strains and 8 strains of 7 strains (24.2%) and Klebsiella pneumoniae (21.2%), Escherichia coli (15.2%), 5 strains Aeromonas malt narrow Pseudomonas strains (6.1%). APACHE- II score, length
of stay, and mortality were significantly higher in the patients with multiple drug resistant groups than in the non multidrug resistant group (P < 0.05). Physical and chemical indicators of the two groups were significantly lower than the serum albumin multidrug resistance group was significantly lower than the non multidrug resistance group (P ＜ 0.05), and the other indicators were not statistically significant (P ＞ 0.05). CONCLUSION multi drug resistant leather of gram negative bacilli in patients with severe pneumonia mortality rate increased significantly, in the clinical treatment to comprehensive analysis of multiple factors, strengthen on the detection of drug susceptibility of gram negative bacilli of leather, the reasonable choice of antibiotics, improve the prognosis of the patients.
文章编号：3201803039 中图分类号：R563.1 文献标志码：
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