干预组合对重症医学科呼吸机相关肺炎发病率的影响

Influence of Intervention Integration on Intensiue Care Unit Ventilator Associated Pneumonia Incidence

目的监测重症医学科(ICU)呼吸机相关性肺炎(VAP)的发病率,探讨实施干预组合措施对VAP发病率的影响。方法对2011年6月1日-2012年5月31日ICU使用呼吸机患者478例为监测对象并按时间先后分为两组,对照组按规范方法进行干预,试验组在规范干预基础上再采取组合干预措施,包括:每日评估患者、用一次性呼吸机螺纹管、用床角量角标识抬高床头、床尾设置黄色警示线、调查手卫生依从性等,统计分析两组VAP发病率。结果共监测ICU患者5 937个住院日,使用呼吸机1 510个机械通气日,呼吸机使用率25.43%,发生VAP 60例,VAP发病率为39.74例/1 000机械通气日,其中对照组发生VAP 21例,使用呼吸机343个机械通气日,VAP发病率为61.22例/1 000机械通气日;试验组发生VAP 39例,使用呼吸机1 167个机械通气日,VAP发病率为33.42例/1 000机械通气日,两组发病率差异有统计学意义(χ2=12.702,P=0.000)。结论实施干预组合措施可使VAP发病率显著下降,但仍高于国内外大型医院,基层医院还需不断努力控制好VAP的发病率。

Objective To monitor the incidence of ventilator-associated pneumonia（VAP） in intensive care unit（ICU）,and evaluate the influence of intervention measures on the incidence of VAP.Methods We observed 478 patients in ICU using ventilator from June 1,2011 to May 31,2012,and divided them into two groups based on the time order.Patients in the control group accepted norm interventions,while patients in the experimental group received a combination of interventions based on the norm,and the intervention combination included daily assessment of patients,using a disposable respirator thread tube,bed-head elevation with angle meter,bed end yellow warning line,and hand health compliance investigation.Statistical analysis was made to study the VAP incidence in the two groups.Results ICU patients were monitored for 5 937 days including 1 510 ventilation days for patients using ventilators.The ventilator using rate was 25.43%,and 60 patients were infected with VAP with a VAP incidence of 39.74 per thousand ventilation days.Twenty-one cases of VAP occurred in the control group,using ventilators for 343 ventilation days,and the incidence of VAP was 61.22 per thousand ventilation days.There were 39 VAP cases in the experimental group with 1 167 ventilation days,and the incidence of VAP was 33.42 per thousand ventilation days.And the two incidence rates had a significant difference（χ2=12.702,P=0.000）.Conclusions Although the VAP incidence has been decreased significantly by intervention integration,it is still higher than that in large domestic and foreign hospitals.Thus we must make efforts to control the incidence of VAP.