呼吸机相关性肺炎的临床分析

目的 :探讨呼吸机相关性肺炎 (VAP)的临床特点 ,为防治VAP提供科学依据。方法 :对 2 6例VAP患者的临床特征、病原体的构成、药敏资料等进行回顾性分析。结果 :本组VAP的发生率2 1 7% ,VAP的发生与年龄、疾病的程度、机械通气的时间、体位及鼻胃管等有关。VAP主要病原体为铜绿假单胞、不动杆菌、大肠杆菌及阴沟肠杆菌 ,药敏监测 ,四种细菌广泛耐药 ,结论 :VAP多发生于老年人 ,死亡率高 ,应引起重视。     

呼吸机相关性肺炎的护理预防对策

呼吸机相关肺炎（VAP）指患者在建立人工气道（气管插管或切开）及机械通气48h以后或撤机拔管后48h以内所发生的医院获得性肺炎,是一种严重的院内感染和并发症,是导致院内感染患者死亡增加、住院时间延长及治疗费用增加的主要原因之一。国外报道的VAP发病率为9．O％～69％,病死率为24．0％～76．0％。国内报道的VAP发病率约为60．0％,病死率为32．0％～39．1％。     

54例慢性阻塞性肺疾病患者呼吸机相关性肺炎的临床分析

目的：分析呼吸重症监护病房中慢性阻塞性肺疾病（COPD）患者呼吸机相关性肺炎（VAP）病原学分布特点及相关危险因素。方法：回顾性分析54例行机械通气的COPD患者的临床资料。结果：29例（53．7％）患者发生了VAP,VAP的治愈率为20．7％;好转率为34．5％;死亡13例,病死率为44．8％。未发生VAP的患者为25例,死亡3例,病死率为12%。VAP组的病死率明显高于未发生VAP组（P〈0．05）。其中应用广谱抗菌素合用糖皮质激素（≥7d）患者的VAP发生率高达72％明显高于未合用糖皮质激素或合用糖皮质激素≤7d的患者;VAP中最常见的致病菌是G^-杆菌（82％）,其中铜绿假单胞菌（41％）、肺炎克雷伯氏菌（23％）最常见,其次为大肠埃希氏菌（7％）,G^＋菌以金黄色葡萄球菌、表皮葡萄球菌为主。结论：COPD患者行机械通气VAP的发生率较高,病死率也较高,必须采取综合性的预防措施才能有效控制。明确病原学对经验性治疗有良好的指导意义。     

呼吸机相关性肺炎的病原学分析与临床研究

目的　分析呼吸机相关性肺炎的临床和病原菌特点。　方法　回顾性分析 6 9例合并呼吸机相关性肺炎 (VAP)的机械通气患者的临床资料和病原菌结果。　结果　 6 9例中慢性阻塞性肺病 (COPD) 2 5例 (36 % ) ,神经系统疾病 2 8例 (41% ) (重症肌无力 16例 ,格林巴利综合征 9例 ) ,经鼻气管插管 8例 ,气管切开 6 1例。使用H2 阻滞剂或抗酸剂 39例 (5 7% ) ,留置胃管 2 3例 (33% ) ,临床表现发热 4 7例 (6 8 1% ) ,寒战 2 4例 (34 8% ) ,表现黄绿色粘稠痰、肺部罗音 5 5例 (79 7% ) ,少量胸腔积液 9例 (13 0 % ) ,白细胞 >10× 10 9 L 5 1例 (73 9% ) ,病原菌主要为革兰阴性杆菌 (GNB) (75 % ) ,铜绿假单胞菌占 2 7 6 % ,且培养菌耐药率高。　结论　机械通气病人免疫力低 ,合并VAP者病原菌耐药率高 ,应注意综合防治     

呼吸机相关性肺炎的发病因素及相关的预防措施

呼吸机相关性肺炎（ventilator associated pneumonia，VAP）为重症病房最常见的医院内获得性感染，具有较高的发病率和死亡率。只有对其发病机制和流行病学有较全面了解，才可能提出合理的预防措施。     

呼吸机相关性肺炎的诊治策略及进展

呼吸机相关性肺炎是机械通气患者中最常见的并发症之一.目前,该病的发病率、病死率逐年升高.本文将近年来有关呼吸机相关性肺炎的诊治进展作一综述,旨在寻找有效的诊疗措施,尤其在合理应用抗生素方面,从而降低呼吸机相关性肺炎的发病率和病死率.     

集束化护理干预预防老年心力衰竭患者呼吸机相关性肺炎的效果分析

目的 探讨集束化护理干预预防老年心力衰竭患者呼吸机相关性肺炎（ventilator associated pneumonia,VAP）的效果。方法 选取本院2021年6月至2022年12月收治的92例老年心力衰竭患者,根据随机数字表法分为两组,每组各46例,对照组机械通气治疗时给予常规护理,观察组机械通气治疗时给予集束化护理,统计两组机械通气治疗期间VAP发生率,比较两组治疗前后的血气分析指标变化、机械通气时间及住院时间。结果 观察组机械通气治疗期间VAP发生率、机械通气时间及住院时间均少于对照组,差异有统计学意义（P<0.05）;观察组治疗后的血氧分压高于对照组,二氧化碳分压低于对照组,差异有统计学意义（P<0.05）。结论 对老年心力衰竭患者机械通气治疗时给予集束化护理干预,可预防VAP,改善血气分析指标,加速疾病康复。     

探讨呼吸机相关性肺炎的发生及护理对策

机械通气是临床治疗急慢性呼吸衰竭的有效方法，献报道10％～25％机械通气患可发生呼吸机相关性肺炎。而呼吸机相关性肺炎常直接威胁患生命。现将我院2004年3月～2005年12月收集的35例呼吸机相关性肺炎作一分析，并提出相应的护理对策。[第一段]     

循证护理在预防呼吸机相关性肺炎中的应用

目的观察循证护理在预防呼吸机相关性肺炎(VAP)中的的效果。方法行机械通气的92例患者随机分为观察组和对照组;两组患者均给予常规护理,观察组患者在此基础上给予循证护理;观察两组患者VAP的发生率。结果机械通气≤3 d和通气在4～7 d的患者中,观察组与对照组患者差异不具有统计学意义(P>0.05);机械通气>7 d的患者中,观察组与对照组差异具有统计学意义(P<0.05);观察组患者VAP总发生率低于对照组(6.7%VS 25.5%),差异具有统计学意义(P<0.05)。结论循证护理干预可以有效预防VAP的发生,值得临床进一步推广和完善。     

脑卒中患者行机械通气继发呼吸机相关性肺炎的影响性研究

目的探讨脑卒中患者机械通气各项影响因素与继发呼吸机相关性肺炎(Ventilator associated Pneumonia,VAP)的影响性。方法回顾性、连续性纳入2014年7月1日-2015年11月1日期间我院重症监护室所收治脑卒中接受机械通气患者的临床资料。纳入患者的一般情况如性别、年龄、体重指数、既往史。登记本次入院期间的插管方式、鼻饲管选择、鼻饲方式、预防应激性溃疡的用药种类、并发症情况、各种分泌物护理情况、气道湿化情况、排痰情况、更换各种呼吸机配件情况、抬高床头角度、院感规避风险、探视情况、是否气管切开等各项细节。以所纳入患者是否继发VAP为因变量,上述登记的各项潜在影响因素为自变量,采用单因素和多因素logistic回归分析研究患者继发VAP的独立影响因素。结果经纳入、排除标准,共纳入96例患脑卒中的手术患者,其中出血性脑卒中17例、缺血性脑卒中79例。累计36例患者于入院一周内继发VAP、60例患者未继发VAP。最终Logistic回归分析结果显示:其中泵注法鼻饲、雾化湿化、定时吸痰、抬高床头为独立保护因素(P0.05);GCS评分、合并神经源性肺水肿、并发胃内容物反流、机械通气时间为独立危险因素(P0.05)。结论影响VAP的发生因素众多,而脑卒中患者的特殊情况又加重了VAP的发病风险,需要全方位、多层次干预。在临床工作中予以充分注重本研究已探明的影响因素,从而切实有效降低VAP的发生。     

An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects

STUDY OBJECTIVES: To determine whether an educational initiative could decrease rates of ventilator-associated pneumonia in a regional health-care system. SETTING: Two teaching hospitals (one adult, one pediatric) and two community hospitals in an integrated health system. DESIGN: Preintervention and postintervention observational study. PATIENTS: Patients admitted to the four participating hospitals between January 1, 1999, and June 30, 2002, who acquired ventilator-associated pneumonia. INTERVENTION: An educational program for respiratory care practitioners and ICU nurses emphasizing correct practices for the prevention of ventilator-associated pneumonia. The program included a self-study module on risk factors for, and strategies to prevent, ventilator-associated pneumonia and education-based in-services. Fact sheets and posters reinforcing the information were posted throughout the ICU and respiratory care departments. MEASUREMENTS AND RESULTS: Completion rates for the module were calculated by job title at each hospital. Rates of ventilator-associated pneumonia per 1,000 ventilator days were calculated for all hospitals combined and for each hospital separately. Overall 635 of 792 ICU nurses (80.1%) and 215 of 239 respiratory therapists (89.9%) completed the study module. There were 874 episodes of ventilator-associated pneumonia at the four hospitals during the 3.5-year study period out of 129,527 ventilator days. Ventilator-associated pneumonia rates for all four hospitals combined dropped by 46%, from 8.75/1,000 ventilator days in the year prior to the intervention to 4.74/1,000 ventilator days in the 18 months following the intervention (p < 0.001). Statistically significant decreased rates were observed at the pediatric hospital and at two of the three adult hospitals. No change in rates was seen at the community hospital with the lowest rate of study module completion among respiratory therapists (56%). CONCLUSIONS: Educational interventions can be associated with decreased rates of ventilator-associated pneumonia in the ICU setting. The involvement of respiratory therapy staff in addition to ICU nurses is important for the success of educational programs aimed at the prevention of ventilator-associated pneumonia.     

Advances in infection control: ventilator-associated pneumonia

Mechanically ventilated patients are 6-21 times more likely to develop nosocomial pneumonia. It is estimated that between 6% and 52% of ventilated patients develop ventilator-associated pneumonia (VAP) with attributable mortality of 27-51%. Certain high risk organisms carry higher mortality (e.g., Pseudomonas aeruginosa and Acinetobacter spp.). Aspiration of colonized orodigestive secretions is the commonly recognized route of infection, whereas inhalation of contaminated aerosol hematogenous spread and direct infection are less common. Gram-negative pathogens are responsible for 40-60% of VAP, whereas gram-positive pathogens cause 15-20%, and it is commonly polymicrobial. Diagnosis remains difficult, and studies showed that early appropriate treatment can improve patient outcome. Better understanding of the pathogenesis and risk factors is important for implementing more effective infection control measures. Clinical trials evaluating outcome will help in assessing current and future preventive and therapeutic measures.     

ICU呼吸机相关性肺炎危险因素分析

目的了解ICU呼吸机相关性肺炎(Ventilator-associated pneumonia,VAP)发生的危险因素,探讨有效的干预措施。方法对本院ICU机械通气患者进行研究,共纳入206例机械通气大于48 h的患者,其中54例发生VAP,152例无VAP发生,比较VAP和非VAP两组患者在年龄、性别、基础疾病、住院时间、机械通气时间等方面的差异。结果我院ICU VAP发生率为26.21%,单因素和多因素Logistic回归分析显示高龄、机械通气时间长、ICU住院时间长、脑血管病、肿瘤术后为VAP发生的独立危险因素,早期康复治疗是VAP的保护性因素。结论 VAP由多种高危因素引起,早期康复治疗有助于预防VAP。     

Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study.

BACKGROUND: Ventilator-associated pneumonia (VAP) is considered to be an important cause of infection-related death and morbidity in intensive care units (ICUs). We sought to determine the long-term effect of an educational program to prevent VAP in a medical ICU (MICU). METHODS: A 4-year controlled, prospective, quasi-experimental study was conducted in an MICU, surgical ICU (SICU), and coronary care unit (CCU) for 1 year before the intervention (period 1), 1 year after the intervention (period 2), and 2 follow-up years (period 3). The SICU and CCU served as control ICUs. The educational program involved respiratory therapists and nurses and included a self-study module with preintervention and postintervention assessments, lectures, fact sheets, and posters. RESULTS: Before the intervention, there were 45 episodes of VAP (20.6 cases per 1000 ventilator-days) in the MICU, 11 (5.4 cases per 1000 ventilator-days) in the SICU, and 9 (4.4 cases per 1000 ventilator-days) in the CCU. After the intervention, the rate of VAP in the MICU decreased by 59% (to 8.5 cases per 1000 ventilator-days; P=.001) and remained stable in the SICU (5.6 cases per 1000 ventilator-days; P=.22) and CCU (4.8 cases per 1000 ventilator-days; P=.48). The rate of VAP in the MICU continued to decrease in period 3 (to 4.2 cases per 1000 ventilator-days; P=.07), and rates in the SICU and CCU remained unchanged. Compared with period 1, the mean duration of hospital stay in the MICU was reduced by 8.5 days in period 2 (P<.001) and by 8.9 days in period 3 (P<.001). The monthly hospital antibiotic costs of VAP treatment and the hospitalization cost for each patient in the MICU in periods 2 and 3 were also reduced by 45%-50% (P<.001) and 37%-45% (P<.001), respectively. CONCLUSIONS: A focused education intervention resulted in sustained reductions in the incidence of VAP, duration of hospital stay, cost of antibiotic therapy, and cost of hospitalization.     

急诊监护病房呼吸机相关性肺炎影响因素及其病原菌特点分析

目的 分析急诊监护病房中呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的影响凶素和致病菌耐药状况.方法 收集2005年5月至2008年5月VAP患者的病原学资料,并与同期未出现VAP患者进行比较.结果 ①机械通气(mechanical ventilation,MV)≥48 h患者178例,65例患者出现VAP(36.5%),18例死亡(病死率27.7%),VAP组病死率明显高于非VAP组(P=0.001);②VAP主要的致病菌以革兰阴性杆菌为主(占77.1%),尤其是绿脓杆菌和鲍曼不动杆菌分离率居多并显示多重耐药:77.3%绿脓杆菌显示出对头孢他啶耐药,72.7%对左氧氟沙星耐药,18.2%对亚胺培南耐药;75.0%的鲍曼不动杆菌对头孢他啶耐药,80.0%对左氧氟沙星耐药,25.0%对亚胺培南耐药;③logistic分析结果显示MV≥7d、应用激素与VAP存在相关性(P<0.05).而广谱抗生素或接触抗生素在3种以上者与VAP致病菌的多重耐药存在显著的相关性(P<0.001).结论 VAP患者具有MV时间长、住院时间长、病死率高等特点;MV≥7 d、应用激素容易导致VAP的发生;VAP的致病菌以多重耐药的革兰阴性细菌为主,广谱抗生素或3种以上抗生素的应用是VAP耐药菌产生的独立危险因素.