目标监测对预防ICU呼吸机相关性肺炎的研究

Effect of targeted monitoring on prevention of ventilator-associated pneumonia in ICU

目的探讨目标监测对降低医院综合ICU呼吸机相关性肺炎(VAP)的作用,为VAP的预防提供科学依据。方法对2010年1月-2012年12月收住综合ICU使用机械性通气48h后或撤机拔管48h内的患者进行目标性监测,并采取一系列医院感染控制干预措施,以患者平均病情严重程度调整法(ASIS)调整医院感染发病率。结果 2 231例患者中发生医院感染313例次,例次感染率14.03%,例次千日感染率为24.04‰,患者ASIS评分3.82分,根据ASIS法调整后患者例次千日感染率为5.11‰;呼吸机置管总天数为6 071d,发生VAP 113例次,2010年VAP的例次千日感染率为27.27‰,采取干预措施后2012年下降至13.70‰;2010-2013年患者ASIS评分值差异无统计学意义。结论通过对综合ICU目标性监测和实施医院感染控制干预措施,可以有效预防和控制VAP的发生。

OBJECTIVE To explore the effect of targeted monitoring on reduction of incidence of ventilator-associat-ed pneumonia （VAP）in the general ICU so as to provide scientific basis for prevention of VAP.METHODS The targeted monitoring was conducted for the patients who underwent mechanical ventilation for 48 hours or were ex-tubated within 48 hours from Jan 2010 to Dec 2012,a series of intervention measures for control of nosocomial in-fections were taken,and the incidence of nosocomial infections was adj usted by using average severity of illness score （ASIS）method.RESULTS The nosocomial infections occurred in 313 case-times among the 2 231 patients, with the case-time infection rate of 14.03% and the case-time thousand day infection rate of 24.04‰.The ASIS of the patients was 3.82 points;the case-time thousand day infection rate was 5.11‰ after it was adjusted according to the ASIS.The total ventilator intubation duration was 6 071 days,the VAP occurred in 113 case-times;the case-time thousand day infection rate of VAP was 27.27‰ in 2010,dropping down to 13.70‰ in 2012 after the intervention measures were taken;there was no significant difference in the average severity of illness score among the patients who were hospitalized from 2010 to 2013.CONCLUSION It is an effective way to conduct the targeted monitoring of the general ICU and take intervention measures for control of nosocomial infections so as to prevent and control the VAP.