NICU常频机械通气并呼吸机相关性肺炎的临床探讨

Clinical research of neonates ventilator-associated pneumonia with normal frequency mechanical ventilation in neonatal intensive care unit

目的:探讨常频机械通气的新生儿并呼吸机相关性肺炎(VAP)的临床特点及防治措施。方法:对1999年6月～2004年6月接受呼吸机治疗的219例新生儿危重患儿并发VAP67例进行回顾性分析。结果:显示并发VAP67例,发生率为30.59%,治愈52例,治愈率为77.61%,死亡13例,病死率为19.40%,其中10例为早产儿,占76.92%。其主要致病菌为革兰氏阴性菌,占91.04%。结论:NICU常频机械通气并发VAP的病例中,通气时间越长、胎龄愈小、出生体重越低,并发VAP的发生率越高,早产儿病死率较高,预后较差。为减少VAP发病率及提高治愈率,采取以下措施:①严格消毒隔离及有效洗手;②尽量缩短通气时间;③选用细菌敏感的抗生素,避免常规性和经验性抗生素使用;④加用丙种球蛋白,可以预防和提高疗效。

Objective:To explore the clinical characteristics of neonates ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU) and its preventive measures.Methods:219 neonates accepted mechanical ventilation in NICU from June 1996 to June 2004, in which 67 ones complicated with VAP,were retrospectively analyzed.Results:Of these neonates,the morbidity of VAP was 30.59% (67/219) and 77.61% (52/67) was recovered, 19.40% (13/67) was died of VAP.10 cases were of premature infants (76.92%). The main pathogens (91.04%) of VAP was gram's stain negative germina.Conclusion:These factors such as prolongation of mechanical ventilation duration, less week of infant age and lower born weight could increase the morbidity of VAP significantly. The mortality of premature infant was higher, the prognosis is worse than that in normal full term neonates.Some measures were helpful to decrease morbidity of VAP, such as strict disinfection and isolation, shortening mechanical ventilation time as possible, using γ-globin and sensitive antibiotics basis on sensitivity tests .