普通外科ICU机械通气患者VAP发生率现状分析及护理对策

The incidence and nursing measures for ventilator-associated pneumonia in general surgical ICU

目的对普通外科ICU机械通气患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生率现状及高危因素进行研究,为制订改进措施提供依据。方法对入住普通外科ICU行机械通气的178例进行观察,运用VAP集束化套餐对患者进行护理,分析VAP的高危因素,并对结果进行统计学分析。结果普通外科ICU机械通气患者VAP发生率为17.42%,VAP发病率平均为21.62/1000通气日,病死率12.90%,因感染VAP延长ICU住院时间为(20.7±5.72)d。VAP发生高危因素由高到低依次为:机械通气时间、人工气道的管理与更换、呼吸机环路的更换与消毒、营养支持途径和抗生素的使用管理,发生VAP涉及医疗、护理、患者、设备等环节。结论运用预防套餐有助于缩短机械通气时间和降低VAP发生率,VAP高危因素中机械通气时间的比例最高,要减少VAP的发生率应对高危因素的各个环节进行综合治理。

Objective To evaluate the incidence of ventilator-associated pneumonia and its risk factors in the general surgical ICU and offer potential improving measures. Methods 178 patients with mechanical ventilation in the general surgical ICU were observed and VAP prevention bundle was applied. The risk factors for VAP were explored and the results were statistically analyzed. Results The incidence of VAP was 17. 42% for all patients and 21. 62 per 1000 ventilation days. The overall mortality was 12. 90% and the occurrence of VAP prolonged ICU stay at an average of（ 20. 7 ± 5. 72） d. Risk factors for VAP were duration of mechanical ventilation,artificial airway management and replacement,change and disinfection of the loop,nutritional support and the use of antibiotics.Many aspects including medical management,nursing,patients,equipment etc. Conclusion The use of preventive bundles helped shorten the duration of mechanical ventilation and reduce the incidence of VAP. Mechanical ventilation duration was the most important risk factor for the development of VAP and comprehensive measures should be taken to reduce the incidence of VAP.