ICU患者呼吸机相关性肺炎临床特征分析

Analysis of the Clinical Features of ICU Patients with Ventilator-associated Pneumonia

目的:研究ICU患者呼吸机相关性肺炎(VAP)的临床特征及原因,并分析其临床应用价值。方法:选取本院2011年1月-2012年6月收治的300例重症患者作为A组,分析其临床特征与资料,制订预防措施,另选取2012年7月-2013年12月本院收治的100例重症患者作为B组,按照随机数字表法将B组分为试验组和对照组各50例,试验组接受VAP预防及干预,对照组不做处理,观察比较两组患者的临床疗效。结果:A组患者中68例符合VAP诊断标准,则VAP发生率为22.67%,VAP患者的病死率为11.76%;68例VAP患者通过病原菌检测共分离出细菌79株,真菌23株,革兰阴性杆菌占比为51.96%,革兰阳性杆菌占比为25.49%,真菌占比为22.55%;VAP发生的高危因素有患者年龄、休克、慢性肺部疾病、机械通气时间、使用制酸剂、使用皮质激素;B组试验组中VAP发生率为2.0%明显低于对照组的24.0%,比较差异有统计学意义(P<0.05)。结论:探讨ICU患者呼吸机相关性肺炎(VAP)的临床特征及原因,具有重要的应用价值。

Objective：To study the clinical characteristics and causes of ventilator-associated pneumonia in patients receiving ICU（VAP）,and analyze its clinical application value.Method：300 severe patients in our hospital from January 2011 to June 2012 were selected as the group A,which clinical features and data were analyzed to formulate prevention measures.At the same time,100 severe patients in our hospital from July 2012 to December 2013 were selected as the group B and randomly divided into the experimental group and the control group,50 cases in each group.The experimental group was given VAP prophylaxis and intervention strategy,while the control group not,and the clinical curative effects between the two groups were observed and compared.Result：There were 68 patients diagnosed as VAP in Group A （22.67%）,which mortality was 11.76%.There were 79 strains of bacteria （51.96% gram negative bacilli and 25.49% gram positive bacilli） and 23 strains of fungi（22.55%） founded in the pathogen detection assay of VAP patients in Group A.Otherwise,we found that age,shock,chronic lung disease,duration of mechanical ventilation,the use of antacids and corticosteroids were all high risk factors for VAP.Further more,the VAP incidence rate of experimental group was 2.0%,it was significantly lower than the 24.0% of control group,the difference was statistically significant（P〈0.05）. Conclusion：Our research results show that it has important application value to study the clinical features and reasons of ventilator-associated pneumonia （VAP） in ICU.