呼吸机相关性肺炎发病特征及医源性危险因素的研究

Study of the disease characteristics and iatrogenic risk factor of ventilator-associated pneumonia

目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)发病特点和独立医源性危险因素,以期指导临床治疗。方法收集我院ICU2007年1月1日至2008年6月30日间行机械通气的127例病例的临床资料,按诊断标准分发生VAP组和未发生VAP组,对两组患者的临床特点、相关医源性危险因素、病原菌分布和预后等进行比较分析。结果VAP发生率为33.1%;停留鼻胃管或鼻空肠管,洗胃机洗胃,禁食3d以上,应用制酸剂或H2受体拮抗剂,持续3d以上使用激素,应用第3代头孢是发病关系密切的医源性危险因素;分离出的致病菌以革兰阴性杆菌为主,大部分致病菌对常用抗菌药物表现出耐药性。结论预防VAP首先应针对发生VAP的医源性危险因素采取相应的措施。

Objective To investigate the disease characteristics and independent iatrogenic risk factor of ventilatorassociated pneumonia （VAP） in intensive care unit （ICU）, and hence to guide clinical treatment. Methods 127 mechanical ventilation patients admitted to the ICU from Jan. 2007 to Jun. 2008 were divided into two groups, one with VAP, and the other without VAP. The comparative analysis was performed in clinical characteristics, iatrogenic risk factors, distribution of disease - producing germs and prognosis. Results The morbidity of VAP was 33.1%. Indwelling nasogastric tubes, lavaging stomach with electric gastrolavage machine, fasting over 3 days, taking antacids or histamine type 2 blockers, using corticosteroid over 3 days and employing the third generation cephalosporin are the independent iatrogenic risk factors of VAP. The Gram - negative bacilli were the major disease - producing germs, most of them showed resistance to commonly used antibiotics. Conclusion The prevention from VAP should take some measures to reduce iatrogenie risk factors.