急诊插管后呼吸机相关性肺炎的危险因素及对策

Risk factors and prevention countermeasures for ventilator-associated pneumonia after intubation in emergency services

目的探讨急诊插管后呼吸机相关性肺炎的危险因素及处理对策,以降低呼吸机相关性肺炎的发生率和病死率。方法回顾性分析医院2009年1月-2010年6月125例急诊机械通气治疗患者的临床资料,分析呼吸机相关性肺炎发生的危险因素、病原菌分布和预后。结果 125例患者中,发生呼吸机相关性肺炎者36例,发生率为28.8%;年龄、机械通气时间、留置胃管、心肺脑复苏、再插管和抗菌药物的应用等与呼吸机相关性肺炎的发生有明显的相关性(P<0.05),缩短上机时间和合理应用抗菌药物可以有效预防呼吸机相关性肺炎的发生。结论急诊插管后呼吸机相关性肺炎的危险因素复杂,缩短上机时间和预防性应用抗菌药物,可以减少其发生。

OBJECTIVE To explore the risk factors and prevention countermeasures of developing ventilator-associated pneumonia（VAP） after intubation in emergency services,to decrease the incidence and mortality of ventilator-associated pneumonia.METHODS The clinical data of 125 patients who had taken mechanical ventilation in emergency services during Jan 2009-Jun 2010 were retrospectively analyzed.The risk factors,pathogen distribution and prognosis of ventilator-associated pneumonia were detected.RESULTS Of 125 cases,36 patients（28.8%） developed ventilator-associated pneumonia.Ventilator-associated pneumonia was significantly associated with using the ventilator included age,the timing,indwelling gastric tube,cardiopulmonary resuscitation,reintubation and prior antibiotics use.Shortening the machine time and reasonable use of antibiotics could be effective in preventing ventilator-associated pneumonia.CONCLUSION The risk factors causing ventilator-associated pneumonia after intubation in emergency service are complicated,and shortening the machine time and reasonable use of antibiotics can be effective in preventing ventilator-associated pneumonia.