呼吸机相关性肺炎高危因素分析与对策

摘要

Objective To analyze the high risk factor of ventilator associated pneumonia(VAP),make nursing measures so as to prevent and reduce the occurrence of YAP.Methods The clinical data of233 patients with mechanical ventilation were collected from February to December 2008 in ICU; analyzed the cause of VAP and take the corresponding measures.Results The incidence of VAP was 72 cases and the infection rate was 30.99%;and 33 cases improved or cured,30 cases died and 9 cases unrecovered.The incidence of VAP was 51.9%(56/108)if the hospitalization time was over 7 days and 68.6%(24/35)if mechanical ventilation over 14 days.The incidence of VAP was significant difference between tracheotomy&indwelling gastric tube patients and non-tracheotomy patients(P<0.05);the difference of YAP inci-dence had no significance between coma patients and non-coma patients(P>0.05).Conclusion The high incidence of VAP is associated with several clinical factors,including hospitalization time,mechanical ventilation time,tracheotomy and indwelling gastric tube.According these high risk factors,taking and carrying out all nursing measures are a key to control infection and improve the success rate of rescue.%目的 调查分析重症监护病房(ICU)呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)发生的高危因素,制定护理措施,以预防和减少VAP的发生.方法 收集2008年2至12月在综合ICU住院并行机械通气的233例患者资料,对发生VAP情况进行调查分析,并采取相应措施.结果 233例患者中发生VAP72例,感染率为30.9%;其中好转或治愈33例,死亡30例,未愈9例.VAP发生率:住ICU时间>7 d者为51.9%(56/108),机械通气时间>14d者为68.6%(24/35).气管切开、留置胃管者的VAP发生率与气管未切开、未留置胃管之间的差异有统计学意义(P<0.05),而昏迷者与未昏迷者VAP发生率、差异无统计学意义(P>0.05).结论 ICU患者VAP的高发生率与多种临床因素,如住院时间、机械通气时间、气管切开、留置胃管有关.针对这些高危因素,制订和落实各项护理措施,是控制感染、提高抢救成功率的关键.