重症监护病房患者呼吸机相关性肺炎发生原因分析及对策

Analysis of the Causes of Ventilator-associated Pneumonia in ICU Patients and Countermeasures

目的探讨重症监护病房发生呼吸机相关性肺炎的危险因素及相关的对策，以降低呼吸机相关性肺炎的发生率，使患者尽早康复。方法随机选取该院内科收治ICU住院行机械通气治疗后发生VAP的198例患者的完整资料。其中男102例，年龄在21．78岁；女96例，年龄在26～82岁，平均年龄在（60±5．8）岁。原发病为：呼吸系统疾病85例，消化系统疾病60例，神经系统疾病35例。其他疾病18例。结果在198例患者中，发现VAP69例，感染率为34．8％；痰标本的培养细菌共131株，其中革兰氏阴性杆菌77株（58．8％），革兰氏阳性杆菌39株（29．8％），真菌15株（11．4％）；其中铜绿假单胞菌是感染菌中最活跃最常见的：机械通气的时间越长，发生呼吸机相关性肺炎的可能会相对增加。差异有统计学意义（X2=187．02,P〈0．001）。结论除患者自身的原发疾病外，机械通气的使用、病房环境感染、患者及护理人员因素、侵入性操作、抗生素的滥用等都会影响病人发生VAP。

Objective To analyze the risk factors of ventilator-associated pneumonia in ICU and relevant countermeasures, in or- der to reduce the incidence of ventilator-associated pneumonia and enable patients to recover as soon as possible. Methods The data of 198 cases of patients suffering from VAP admitted in Department of Internal Medicine of our hospital after the treatment of mechanical ventilation in ICU were selected. Among them, there were 102 males, aged from 21 to 78, 96 females, aged from 26 to 82; the average age was 60±5.8 years old. Primary disease： 85 cases of respiratory system diseases, 60 cases of digestive system dis- eases, 35 cases of nervous system diseases, and 18 cases of other diseases. Results Among the 198 patients, there were 69 patients with VAP, the infection rate was 34.8%; a total of 131 strains of bacteria were isolated from sputum samples, including 77 strains of gram negative bacilli （58.8%）, 39 strains of gram positive bacteria （29.8%）, 15 strains of fungi （11.4%）; wherein the pseu- domonas aeruginosa was the most active and common infection bacterium; the longer duration of mechanical ventilation, the occur- rence of ventilator-associated pneumonia might relatively increase（X2=187.02, P〈0.001）, the difference was statistically significant. Conclusion In addition to the patient＇s own primary disease, the use of mechanical ventilation, the infection of ward environment, patients and nursing staff factors, invasive operation and the abuse of antibiotics, all these can cause the patients with VAP.