呼吸机相关性肺炎的危险因素分析及防控

Analysis and Prevention and Control of the Risk Factors of Ventilation-associated Pneumonia

目的:分析探讨重症医学科(ICU)发生呼吸机相关性肺炎(VAP)的危险因素及防控措施。方法:回顾性分析128例机械通气(MV)≥48h患者的临床资料,针对性提出有效的预防控制措施。结果:呼吸机相关性肺炎的发生与多种因素有关,如MV时间长、年龄≥65岁、营养状况差、合并慢性基础疾病、长期吸烟史、留置胃管、多器官功能障碍综合征(MODS)、使用制酸剂、平卧位等(P<0.05或<0.01);VAP患者死亡率显著高于非VAP患者,差异有统计学意义(P<0.05)。结论:VAP的发生与多种危险因素相关,主要危险因素为MV时间长(≥7d)、年龄≥65岁、同时存在≥3种危险因素,VAP导致ICU较高的死亡率,应针对可变危险因素采取预防控制措施。

Objective：To analyse and investigate the risk factors and the prevention and control measures of ventilation-associated pneumonia（VAP）in intensive care unit（ICU）.Methods：The clinical data of 128 cases with mechanical ventilation（MV）over 48 hours was retrospectively analyzed,and effective measures of prevention and control were targeted put forward.Results：The occurrence of ventilation-associated pneumonia is associated with many factors,such as long MV time,age older than 65,poor nutritional status,and chronic diseases,long-term smoking history,indwelling gastric tube,multiple organ dysfunction syndrome（MODS）,the use of antacids,horizontal position and so on（P〈0.05or0.01）;the fatality rate of VAP patients was higher than that of non-VAP patients,and the differences are statistically significant（P〈0.05）.Conclusion：The occurrence of ventilation-associated pneumonia is associated with many factors.The main risk factors are long MV time（≥7days）,age older than 65,and there are three or more risk factors at the same time.VAP leads to higher mortality rate in ICU,and prevention and control measures should be taken according to the variable risk factors.