呼吸机相关性肺炎感染的危险因素分析

Risk factors for ventilator-associated pneumonia

目的从护理的角度分析呼吸机相关性肺炎(VAP)感染的危险因素,探讨最佳的护理预防措施,从而有效减少呼吸机相关性肺炎的发生率和病死率。方法对医院ICU108例行机械通气患者VAP感染危险因素进行回顾性调查分析,提出科学有效的护理预防控制措施。结果 108例患者中20例发生VAP,发生率18.5%,其中9例经治疗好转成功脱机,占45.0%,另有9例死亡,占45.0%,2例自动出院;经调查呼吸机相关性肺炎与患者年龄、意识障碍、住院时间、基础疾病(主要为慢性阻塞性肺疾病)、长时间不合理使用抗菌药物及侵入性操作密切相关(P<0.05)。结论严格执行无菌操作、确保患者呼吸道通畅,加强和重视口腔护理及预防患者误吸和反流,正确有效吸痰等针对性的护理干预措施,可有效减少VAP的发生率和病死率。

OBJECTIVE To analyze the risk factors for the ventilator-associated pneumonia（VAP）from the perspective of nursing and explore optimal nursing measures so as to effectively reduce the incidence of VAP and the mortality.METHODS Totally 108cases of patients who underwent the mechanical ventilation in ICU were enrolled in the study,the risk factors for the VAP that occurred in the subjects were retrospectively analyzed,and the scientific and effective nursing measures for the control of VAP were put forward.RESULTS Of totally 108patients investigated,the VAP occurred in 20cases with the incidence rate of 18.5%,among which 9cases were improved through treatment and successfully withdrawn the ventilators,accounting for 45.0%,9cases died,accounting for 45.0%,and 2cases were voluntarily discharged.The result of the study indicated that the incidence of VAP was closely related to the age,consciousness disturbance,length of hospitalization,underlying diseases（especially the chronic obstructive pulmonary disease）,long term of unreasonable use of antibiotics,and invasive operation（P 0.05）.CONCLUSIONThe implementation of targeted nursing interventions,including strict aseptic operation,patency of the respiratory tract,paying attention to oral nursing to prevent aspiration and regurgitation,and correct and effective suction,can effectively reduce the incidence of VAP and the mortality.