胸外科手术后医院获得性肺炎的前瞻性监测与干预研究

Prospective monitoring of hospital acquired pneumonia in thoracic surgical patients and intervention measures

目的探讨胸外科手术后医院获得性肺炎的预防控制措施。方法采用前瞻性监测方法，通过集束干预包括加强培训、呼吸机管路的严格消毒、床头抬高30°、洗必泰口腔护理、每天评估是否撤机、加强手卫生等综合措施，监测胸外科手术后医院获得性肺炎发病率。结果通过集束干预措施，手卫生依从率明显提高，床头抬高30°、洗必泰口腔护理每2～6小时1次、每天评估是否撤机干预措施执行情况优于干预前，胸外科手术后医院获得性肺炎发病率由监测前的25．87％下降至9．02％，差异有统计学意义（X^2=44．956，P〈0．05）。结论开展前瞻性监测，实施集束干预措施，对控制胸外科手术后医院获得性肺炎有积极意义，降低了手术后医院获得性肺炎的发病率。

Objective To study the prevention and control measures for hospital acquired pneumonia in thoracic surgical patients. Methods Using the prospective monitoring, morbidity rate of hospital acquired pneumonia in thoracic surgical patients was monitored. The cluster intervention measures were taken, such as education training, strictly disinfecting the respirator duct, raising up the patientsr bedside 30°,conducting oral cavity nursing with hlorhexidine, making assessment everyday to determine the withdrawal of the respirator, and strict hand hygiene. Results By cluster intervention measures, theimplementation of hand hygiene of the medical staff was significantly improved; intervention measures including raising up the patients＇ bedside 30°, conducting oral cavity nursing with hlorhexidine, makingassessment everyday to determine the withdrawal of the respirator were enforced well. The morbidity rate of hospital acquired pneumonia in thoracic surgical patients fell from 25.87% to 9.02% （ P〈0.05）.Conclusions It is a positive significance for the prevention and control of the hospital acquired pneumonia in thoracic surgical patients through cluster intervention measures.