综合ICU呼吸机相关性肺炎患者的护理干预研究

Nursing interventions to patients with ventilator-associated pneumonia in comprehensive ICU

目的评价不同护理管理措施对综合ICU呼吸机相关性肺炎(VAP)发生的影响,为VAP的预防与控制提供依据。方法对2010年1月-2012年12月综合ICU患者实施护理干预,对比分析干预前后VAP发生率、感染率、病原菌检出率等资料,采用SPSS 17.0软件进行统计分析。结果 ICU 2 244例住院患者中使用呼吸机1 484例,呼吸机使用率66.13%,发生VAP136例,发生率9.16%;经趋势χ2检验,呼吸机使用率从护理干预前的60.24%上升至干预后2012年的71.36%,逐年上升(χ2=20.041,P<0.001),VAP发生率从护理干预前的14.86%下降至干预后的5.14%,呈逐年下降趋势,各年度检出的病原菌中多药耐药菌构成比亦呈下降趋势。结论在病区布局合理的基础上,改进口腔护理、气道管路护理措施可控制呼吸机相关肺部感染的发生,降低VAP患者多药耐药菌感染风险。

OBJECTIVE To evaluate the influence of different nursing interventions on incidence of ventilator-associated pneumonia（VAP）in the comprehensive ICU so as to provide guidance for prevention and control of VAP.METHODS The nursing interventions were taken for the patients who were treated in the comprehensive ICU from Jan 2010 to Dec 2012.The data including the incidence of VAP,infection rate,and detection rates of pathogens were observed and compared before and after the interventions were taken,and the statistical analysis was performed with the use of SPSS17.0software.RESULTS Of 2244 hospitalized patients in the comprehensive ICU,1484 cases used ventilators,with the utilization rate of 66.13%,and 136 cases had VAP,with the incidence rate of9.16%.The chi-square test revealed that the utilization rate of ventilators increased from 60.24% before the nursing interventions were taken to 71.36% after the interventions were taken in 2012,showing an upward trend（χ2=20.041,P〈0.001）,and the incidence of VAP decreased from 14.86% before the nursing interventions were taken to 5.14% after the nursing interventions were taken,showing an downward trend;the constituent ratio of the multidrug-resistant bacteria among the isolated pathogens in each year presented a downward trend.CONCLUSION On the basis of the reasonable layout of wards,the improvement of oral care and implementation of nursing interventions to airway pipelines may contribute to the control of ventilator-associated pulmonary infections and the reduction of risk of the multidrug-resistant bacteria infections in the VAP patients.