无创通气慢性阻塞性肺疾病患者下呼吸道医院感染预防与控制

摘要

目的：了解无创通气慢性阻塞性肺疾病(COPD)患者的医院感染情况，探讨预防和控制医院感染的有效措施。方法以2014年1~12月干预前123例无创通气COPD并Ⅱ型呼吸衰竭患者为对照组，2015年1~12月干预后112例无创通气COPD并Ⅱ型呼吸衰竭患者为干预组，对比干预前后两组患者下呼吸道医院感染的感染率，每通气日感染率，住院时间和无创通气时间，并对其下呼吸道医院感染的病原菌进行分析。结果与对照组比较，干预组的下呼吸道医院感染率[14.63%(18/123) vs 6.25%(7/123)]，每通气日感染率(17‰vs 7‰)，住院时间[(12.32±2.61) d vs (10.17±1.79) d]均明显下降，差异均有统计学意义(P<0.05)；下呼吸道的医院感染菌主要为铜绿假单胞菌(10株，35.7%)和鲍曼不动杆菌(7株，25.0%)。结论对无创通气COPD并Ⅱ型呼吸衰竭患者采取系统的预防干预措施，可以降低下呼吸道医院感染率，缩短住院时间。%Objective To investigate the hospital infection rate of patients of chronic obstructive pulmonary diseases (COPD) treated with noninvasive ventilation, and to explore the effective measures for the control of hospital in-fection. Methods One hundred and twenty-three patients of COPD complicated with typeⅡrespiratory failure treated with noninvasive ventilation before intervention from Jan. 2014 to Dec. 2014 were used as control group, and 112 COPD patients complicated with type Ⅱ respiratory failure treated with noninvasive ventilation after intervention from Jan. 2015 to Dec. 2015 were enrolled as intervention group. The hospital infection rate of lower respiratory tract, the hospital infection rate of per ventilation day, the length of stay in hospital and the length of ventilation were observed and com-pared in the two groups. The pathogen of lower respiratory tract was analyzed. Results The hospital infection rate (14.63% vs 6.25%) of lower respiratory tract, the hospital infection rate of per ventilation day (17‰vs 7‰) and the length of stay in hospital ((12.32±2.61) d vs (10.17±1.79) d) decreased significantly in the intervention group as com-pared with those in the control group (P<0.05). Pseudomonas aeruginosa (n=10, 35.7%) and Acinetobacter baumannii (n=7, 25%) were the main pathogens. Conclusion The standard interventions may reduce the hospital infection in COPD patients complicated with type Ⅱ respiratory failure treated with noninvasive ventilation, and also shorten the length of stay in hospital.