呼吸机相关性气管支气管炎研究进展

Research progress of ventilator-associated pneumonia

在重症监护室机械通气的患者中，下呼吸道感染有很高的发病率，并且也是死亡的重要原因。对于呼吸机相关性肺炎（VAP）的治疗和预防已有很多认识，但是对于呼吸机相关性气管支气管炎（VAT）的研究却很少。VAT是一种相对局限性的疾病，由于目前还没有对VAT明确的统一定义，所以很难对VAT和VAP进行鉴别。如果患者出现下呼吸道感染，微生物检查阳性，胸片没有新的或进行性加重的浸润影，就应该考虑到VAT，如果进一步发展就可能转化成VAP，故对VAT有针对性的抗生素治疗可能是预防VAP和改善患者治疗效果的新策略。

Nosocomial lower respiratory tract infection is a common cause of morbidity and mortality in ICU patients receiving mechanical ventilation. Many studies have investigated the management and prevention of ventilator-associated pneumonia （VAP）, but few focused on the role of ventilator-associated tracheobronchitis （VAT）. VAT is a localized disease, since there is no well- established definition of VAT,discrimination between VAT and VAP is challenging. VAT is suspect with clinical signs （fever, leukocytosis, and purulent sputum）, and the absence of a new infiltrate on chest radiograph. The pathogenesis of lower respiratory tract infections often begins with tracheal colonization that may progress to VAT, and in selected patients to VAP, which targeted antibiotic therapy for VAT may be a new paradigm for VAP prevention and better patient outcomes.