新生儿呼吸机相关性肺炎的危险因素分析与对策

Analysis of Risk Factors of VAP and the Coping Nursing

目的探讨在新生儿重症监护病房(neonatal intensive care unit,NICU)中使用机械通气发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的危险因素,提出预防VAP的防治措施,减少VAP的发生。方法对我院NICU2006年5月-2008年5月期间在我院NICU进行机械通气治疗的72例患儿的临床资料做回顾性分析,统计并分析发生VAP的患儿例数,以及患儿的胎龄、出生体质量和机械通气时间,提出相应防治措施。结果胎龄<30周的新生儿VAP的发生率明显高于胎龄>37周的新生儿(足月儿)(P<0.01);出生体质量<1500g的患儿较1500～2500g和>2500g的患儿VAP发生率明显增高(P<0.05或P<0.01),出生体质量1500～2500g的患儿较>2500g患儿VAP发生率明显增高(P<0.05);机械通气时间<3d的患儿较3～7d和>7d的患儿VAP发生率明显降低(P<0.01)。结论VAP为医院获得性感染,及早防治新生儿呼吸窘迫综合征,尽量缩短机械通气时间,加强护理胎龄小和出生体质量低的患儿,以减少VAP的发生,提高机械通气的抢救成功率。

Objective To study the risk factors of VAP of neonates in neonatal intensive care unit （NICU）, so as to formulate the precautions and methods of treatment and minimize the incidence of this diseases. Methods A retrospective analysis was made of the date of the 72 child patients undergone mechanical ventilation treatment in our hospital between May, 2006 and May, 2008. The number of the cases with VAP was recorded, and the patients＇ fetal age, birth-time body mass and time of mechanical ventilation were analyzed. Results Those whose fetal age was less than 30 weeks had a distinctly higher rate of VAP than the full fetal age group （P〈0.01）, and those whose birth-time body mass was less than 1 500 g displayed a markedly higher rate of VAP than those whose body mass ranged between 1 500 and 2 500 g and more than 2500g （P〈0.05, P〈0.01）, and those whose birth-time body mass ranged between 1 500 g and 2 500 g showed a distinctly higher rate of VAP than those who weighed more than 2 500 g at birth（P〈 0.05）; the incidence rate of VAP among those who had the mechanical ventilation for less than 3 d was distinctly higher than that among those who did for 3 to 7 d or more （P〈0.01）. Conclusion Minimizing the time of mechanical ventilation and strengthening the nursing for neonates with small fetal age and birth-time body mass is vital for reducing the incidence of VAP.