急诊插管后呼吸机相关性肺炎发生的危险因素及对策

目的 分析急诊插管后呼吸机相关性肺炎(VAP)发生的危险因素及预防.方法 对医院自2009年4月-2011年12月在急诊科室行紧急插管后进行机械通气而引发VAP的患者108例,选择同时期未感染VAP行插管的76例患者作为对照组,对发生VAP的危险因素(患者年龄、机械通气时间、心肺脑复苏、胃部内容物的吸入等)进行统计分析.结果 患者的年龄、再插管、机械通气时间、胃内容物的吸入等与VAP的发生具有明显的相关性(P＜0.05)；机械通气2～5 d时的VAP发生率为21.03％,＞5 d的发生率为56.98％；术前抗菌药物的合理应用具有明显的预防效果(P＜0.05).结论 VAP在急诊插管中具有高发生率,同时在治疗过程中具有一定的难度；结合其特点,应该以预防为主,减少机械通气的时间,配合合理的抗菌药物,降低VAP的发生率.

Risk factors and countermeasures for ventilator-associated pneumonia after emergency intubation

OBJECTIVE To study the risk factors and countermeasures for ventilator-associated pneumonia(VAP) after emergency intubation.METHODS A total of 108 patients with ventilator-associated pneumonia,due to emergency intubation for mechanical ventilation from Apr 2009 to Dec 2011,were chosen,at the same time,76 intubation patients without VAP were set as the control group,the risk factors for VAP,including the age,duration of mechanical ventilation,cardiopulmonary cerebral resuscitation,and inhalation of stomach contents,were taken for statistical analysis.RESULTS By the comparison,there was an significant correlation between the age of the patients,re-intubation,duration of mechanical ventilation,gastric contents aspiration and the incidence of VAP(P<0.05);the incidence of VAP in the patients with the mechanical ventilation duration of 2 to 5 days was 21.03%,the patients with mechanical ventilation duration more than 5 days 56.98%;The rational application of antibiotics before the surgery could achieve a remarkable effect on the prevention of VAP.CONCLUSION The incidence of VAP is high during the emergency intubation and it is difficult to treat.Based on the characteristics of VAP,it is necessary to lessen the use of mechanical ventilation and use the antibiotics reasonably so as to reduce the incidence of VAP.