ICU神经外科患者呼吸机相关性肺炎的临床分析

Analysis of ventilator associated pneumonia in ICU

目的探讨神经外科重症监护室呼吸机相关性肺炎（VAP）的发病率、病死率、危险因素以及诊治体会，为预防和治疗VAP提供科学依据。方法回顾性分析我院外科重症监护中心（ICU）神经外科患者机械通气下发生VAP的患者的临床特征、各种临床资料和痰培养结果，总结诊治经验，并提出相应防治措施。结果在ICU监护的神经外科VAP发生率为37．76％，死亡20例（54．05％），相关危险因素：年龄〉60岁、昏迷、各种侵入性操作、气管切开、慢性阻塞性肺疾病、机械通气〉3d（P均〈0．05）。主要病原体为绿脓杆菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和真菌。结论重症监护室神经外科患者VAP发生率高，长期机械通气患者呼吸机使用时间增加了VAP发生率，且对预后造成不良影响，应尽可能早脱机。

Objective To investigate the neurosurgery intensive care unit ventilator-associated pneumonia （YAP） of morbidity, mortality, risk factors, as well as diagnosis and treatment for the prevention and treatment of VAP and to provide a scientific basis. Kethods A retrospective analysis of hospital surgical ICU patients with mechanical ventilation neurosurgery under the VAP occurred in the clinical characteristics of a variety of clinical information and sputum culture, sunned up the experience of diagnosis and treatment, and the corresponding control measures. Results In the ICU ward of neurosurgery VAP incidence of 37.76 percent, the death of 20 patients （54. 05%）, related risk factors： age〉 60 years old, was in a coma and a variety of invasive operation, tracheotomy, chronic obstructive pulmonary disease, mechanical ventilation 〉 3d （P all 〈0.05）. The main pathogens as Pseudomonas aeruginosa, Escherichia eoli, Klebsiella pneumoniae, Enterobacter cloacae and fungi. Conclusions The neurosurgery intensive care unit patients with high incidence of VAP, a long-term mechanical ventilation in patients with ventilator-time increase in the incidence of VAP, and the adverse impact on the prognosis should be off-line as soon as possible.