ICU呼吸机相关性肺炎发生原因分析及预防对策

目的分析ICU呼吸机相关性肺炎（ventilator associated pneumonia，VAP）的发生原因，探讨预防对策。方法回顾分析463例机械通气患者的临床资料，分析A组（2007年2月一2008年8月，n=248）VAP发生的相关因素，根据影响因素制订预防对策，B组（2008年9月～2010年2月，n=215）接受VAP预防及干预。结果①A组248例机械通气患者发生VAP的相关因素分析结果显示，VAP发生的患者因素有患者年龄大、出现昏迷、伴有原发性肺部疾病，医源性因素包括机械通气时间长、采用平卧位、无使用抗生素、使用H2受体阻滞剂、使用皮质激素；②B组215例ICU机械通气患者经VAP预防及干预后，有13例发生VAP，发生率为3．72％（13／215），两组的VAP发生率有显著性差异（P〈0.05）。结论分析VAP发生的原因并采取相应的预防措施．可以有效降低VAP的发生率．具有首要的临床意义．

Analysis of factors for ventilator-associated pneumonia in ICU and protection countermeasures

Objective To analyze factors for VAP in ICU and to explore its protection countermeasures. Methods The clinical data of 463 patients in ICU were analyzed retrospectively. Analyzed factors of VAP in A ~,xoup （from Feb 2007 to Aug 2008,n=248） and provided the guidance for preventing VAP. B group （from Sep 2008 to Feb 2010,n=215） took VAP pre- vention. Results （~）Single factor analysis of the A group showed that factors associated with VAP were patients＂ age,coma, primary pulmonary disease, long duration of mechanical ventilation, took supine position, without antibiotics,the use of H2 blockers and corticosteroids. （~）The VAP rate of the B group was 3.72% （13/215） and it＇s obvious lower than that of the A group. Conclusion Analyzing the reasons for the incidence of VAP and taking appropriate preventive measures can reduce the incidence of VAP effectively.