呼吸机相关性肺炎的危险因素和护理对策

目的探讨呼吸机相关性肺炎（VAP）的危险因素，并观察有针对性的护理对降低VAP的作用。方法回顾性分析134例机械通气患者的资料，分析VAP发生率和危险因素；另将114例行机械通气的患者随机分为研究组和对照组，研究组采用针对危险因素的护理，对照组采用一般护理，比较VAP发生率。结果134例患者发生VAP46例，发生率为34．33％。Logistic多因素回归显示APACHEⅡ评分、机械通气时间、机械通气方式、体位和湿化器污染是VAP发生的独立危险因素（P〈0．05）。研究组和对照组VAP发生率分别为15．79％和29．82％，差异具有统计学意义（P〈0．05）；2组的病死率、ICU停留时间和治疗费用等比较差异均具有统计学意义（P〈0．05）。结论VAP在ICU内高发，并且与多种危险因素相关；根据危险因素采取有针对性的护理措施，可以明显降低VAP的发生率，改善预后。

A study on the related factors and nursing measures of ventilator associated pneumonia

Objective To explore the related factors of ventilator associated pneumonia （VAP） and put forward nursing measures to decrease the incidence of VAP. Methods The data of 134 patients receiving mechanical ventilation were retrospectively analyzed to determine the incidence of VAP and its related factors. Another 114 patients receiving mechanical ventilation were randomly divided into a research group treated with nursing measures specific to risk factors and a control group treated with general measures. Then, a comparison of VAP incidence was made between each group. Results VAP was found in 46 cases, with an incidence of 34.33%. According to multiple logistic regression, APACHE ]] score, duration and types of mechanical ventilation, body position and heated humidifier pollution were independent risk factors for VAP （P 〈0.05）. The incidence of VAP was 15.79% in the research group and 29.82% in the control group （ P 〈 0.05）. Meanwhile, both group indicated significant difference in mortality, ICU length of stay and treatment cost （ P 〈 0.05 ）. Conclusion VAP is frequently seen in ICU, which is associated with a variety of risk factors. Taking targeted nursing measures according to risk factors can significantly reduce the incidence of VAP, so as to improve prognosls.