泛耐药鲍曼不动杆菌呼吸机相关肺炎巢式病例对照研究

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1、授予单位代码10089学号或申请号13276HebeiMedicalUniversity硕士学位论文科学学位泛耐药鲍曼不动杆菌呼吸机相关肺炎巢式病例对照研究研究生闫振宇导师田庆宝教授专业流行病与卫生统计学二级学院公共卫生学院研究起止日期2013年10月-2014年12月交稿日期2015年3月2015年03月0河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下，由本人独立完成。本学位论文研究所获得的研究成果,其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文,第一署名为单位河

2、北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应法律责任。研究生签名：/i�!了L导师签章二级学院领导盒章：年上月巧曰河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外,文中不包含其他人已经发表或撰写的研究成果，指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名：句移身导师签章：

3、n-对斤年上月"曰目录中文摘要····································································

4、·········1英文摘要·············································································4研究论文泛耐药鲍曼不动杆菌呼吸机相关肺炎巢式病例对照研究前言·············································································7材料与方法····································································8结果············

5、·································································10附图·············································································14附表·············································································15讨论·························································

6、····················18结论·············································································23参考文献·······································································23综述鲍曼不动杆菌呼吸机相关肺炎研究进展··························26致谢···························································

7、························37个人简历·············································································38中文摘要泛耐药鲍曼不动杆菌呼吸机相关肺炎巢式病例对照研究摘要背景：目前，有创机械通气技术正在被广泛应用于重症医学领域。临床中主要用于抢救急慢性呼吸衰竭危重患者，但应用过程中并发症较多,其中呼吸机相关性肺(VAP)是机械通气患者最常见的感染性疾病之一。国外报道，VAP发病率为6％～52％或(1.6-52.7)例／1000机械通气日，病死率为14％-50％；若

8、病原菌是多重耐药菌或泛耐药菌，病死率可达76％,归因死亡率为20％-30％。在我国，VAP发病率在4.7％-55.8％或(8.4-49.3)例／1000机械通气日，病死率为19.4％-51.6％。发生VAP患者机械通气时间延长5.4-14.5d，ICU留治时间延长6.1-17.6d，住院时间延长11-12.5d。呼吸机相关肺炎感染的致病菌中以革兰阴性杆菌为主，其中以铜绿假单胞菌和鲍曼不动杆菌最为常见。鲍曼不动杆菌(Ab)属于条件致病菌，广泛分布于自然环境、医疗场所以及人体皮肤黏膜中。因其可以通过多种途径获得耐药性且克隆传播的能力非常强，目