分析重型脑外伤呼吸机相关性肺炎的危险因素及其护理干预对降低其发生的作用

目的对重型脑外伤呼吸机相关性肺炎的危险因素及护理策略进行分析。方法对62例重型脑外伤后机械通气24 h以上的患者进行回顾性研究,分析其发生呼吸机相关性肺炎的危险因素,认为气道损伤、不合理用药和细菌易位、呼吸治疗相关器械污染、不良卧位、营养不良、基础疾病和不良心理反应是相关危险因素。针对危险因素,制定相应的护理措施。结果落实相应护理措施后,36例单纯气管插管患者仅1例发生呼吸机相关性肺炎,26例气管切开患者有2例发生呼吸机相关性肺炎,总感染率为4.8%,低于国内一般感染率水平（9%-70%）。结论在预防和治疗呼吸机相关肺炎时,通过保护气道、合理用药、严格消毒和无菌操作、体位护理、营养支持、治疗基础疾病治疗和心理护理,可以有效降低其发生率,对改善患者的预后有重要意义。

Study on risk factors for severe traumatic brain injury of ventilator-associ- ated pneumonia and the nursing intervention to reduce it

Objective Analysis of risk factors and nursing strategy for severe traumatic brain injury of ventilator-associated pneumonia and nursing strategy.Methods A total of 62 patients with severe traumatic brain injury and more than 24hours, mechanical ventilation were studied retrospectively.Analyzing the incidence of risk factors of ventilator-associated pneumonia, we think that airway injury, irrational drug use and bacterial transloeation,respiratory therapy equipment pollution, bad position, malnutrition, basic disease and adverse psychological reaction were related risk factors.According to the risk factors, we made the corresponding nursing measure.Results After the corresponding nursing measures were implementated, only 1 case sawthe ventilator associated pneumonia in all 36 patients with tracheal intubation, 2 cases saw the ventilator associated pneumonia in all 26 patients with tra- cheal intubation, the total infection rate was 4.8%, which is lower than the domestic general infection rate （9%~70%）.Conclusion In the prevention and treatment of ventilator associated pneumonia, airway protection, rational drug use, strict sterilization and aseptic operation, posture nursing, nutritional support, treatment on basic disease and of psychological nursingcan effectively reduce the incidence, which have important significance to improve the prognosis of the patients.