96例综合ICU呼吸机相关事件监测及结果分析

摘要

目的:调查本院综合ICU中呼吸机相关事件(ventilator-associated events,VAE)发生情况,并探讨合适的呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)监测诊断方法.方法:采用前瞻性调查方法调查2013年4月至2013年12月本院综合ICU的机械通气的患者,并采用VAE的判断标准进行判断,同时采用现行的VAP目标性监测方法进行比较.结果:共监测病例96例,96例患者使用呼吸机日数为1 544 d.其中呼吸机相关并发症(ventilator-associated complications,VAC)23例,发生率为14.89‰;23例VAC患者中与感染有关的呼吸机相关并发症(infection-related ventilator-associated complications,IVAC)7例,发生率为4.53‰;7例IVAC患者中疑诊VAP 4例,疑诊VAP发生率为2.59‰,拟诊VAP 0例,拟诊VAP发生率为0‰.同期96例患者中采用原方案进行VAP目标性监测,共发现VAP12例,使用呼吸机日数为1 544 d,发生率为7.76‰.结论:美国疾病预防控制中心的VAE监测方案受我国大部分微生物室条件影响,导致诊断敏感性降低,目前尚不适合在我国推广应用.我国现行的VAP诊断方法简便易行,但主观因素较多,易导致诊断误差,故应进一步探寻一种更加适合我国国情的VAP监测方式.%Objective:To investigate the incidence of ventilator-associated events (VAE) in the comprehensive ICU of our hospital and explore appropriate monitoring and diagnostic methods for ventilator-associated pneumonia (VAP).Methods:Patients with mechanical ventilation in the comprehensive ICU of our hospital were investigated prospectively from April to December in 2013.Judgment was performed using the judgment criteria of VAE,and was compared with that performed using the current objective monitoring method of VAP.Results: A total of 96 cases were monitored,96 patients supported for 1544 ventilator-days,with 23 cases of ventilator-associated complications (VAC),the incidence of which was 14.89‰.Among the 23 cases of VAC,there were 7 cases of infection-related ventilator-associated complications (IVAC),the incidence of which was 4.53‰.Among the 7 cases of IVAC,there was 4 case suspected as VAP,the incidence of which was 2.59‰,and there was 0 cases diagnosed as VAP,the incidence of which was 0‰.Over the same period in 96 patients with primary VAP targeted monitoring program,12 cases of VAP was found,ventilator days was 1 544 D,the incidence of which was 7.76‰.Conclusion: The VAE monitoring method recommended by American CDC may have a low diagnostic sensitivity as a result of the condition of most microbiology laboratories in China,thus not appropriate to be widely used in China.Current VAP diagnostic method in China is simple and convenient,but more subjective factors may lead to diagnostic errors.Therefore,a VAP monitoring method that is more suitable to the condition of China should be explored.