重症监护病房呼吸机相关性肺炎的危险因素分析

目的调查医院重症监护病房(ICU)呼吸机相关性肺炎(VAP)的现状,探讨护理预防的对策。方法采用回顾性方法,调查2006～2008年ICU接受呼吸机通气患者中VAP发生率、危险因素、病原菌特点及有效的护理预防措施。结果共调查632例患者,确诊VAP 123例,发生率为19.5%;VAP的发生与年龄高低(χ2=14.56,P0.001)、持续通气时间长短(χ2=38.16,P0.001)呈正相关;COPD、大面积烧伤、心肺复苏、慢性支气管炎继发感染和肺气肿等原发病患者属高危人群;VAP的病原菌主要是白色假丝酵母菌、铜绿假单胞菌、鲍氏不动杆菌、表皮葡萄球菌等条件致病菌。结论严格护理操作,加强护理巡视,做好管道的无菌化管理,机械通气患者应尽量取半坐卧位,维持理想的气囊压力等措施有助于减少VAP的发生。

Ventilator-associated Pneumonia in ICU:Its Risk Factors and Nursing

OBJECTIVE To investigate current status of ventilator-associated pneumonia(VAP)and to discuss nursing measures to prevent it.METHODS The incidence and risk factors of VAP,characteristics of pathogen and effective nursing were investigated in retrospective way in the patients who accepted ventilator.RESULTS There were 632 investigated patients and 123 patients of them were diagnosed hospital infection with the total infection rate of 19.5%.The incidence of VAP was positively correlated with age(χ~2=14.56,P＜0.001)and ventilating time(χ~2=38.16,P＜0.001).Patients who had COPD,large area burn,cardiopulmonary resuscitation and emphysema were high risk populations.The pathogen of VAP were opportunistic pathogens such as Candida albicans,Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus epidermidis and Klebsiella pneumoniae.CONCLUSIONS Some measures such as a strict nursing rule,keeping the ventilator pipeline in asepsis,mechanical ventilation patients in semirecumbent position and keeping perfect balloon pressure are needed to reduce VAP.