神经内科ICU呼吸机相关性肺炎监控及干预措施

Monitoring and interventions for ventilator associated pneumonia in neurological intensive care unit

目的:探讨神经内科ICU患者发生呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的影响因素及干预措施。方法:对我院2013年1月至2013年12月住院的882例神经内科ICU患者进行调查研究,分析患者VAP的发生率、呼吸机连接方式、病原菌特征、高危影响因素。结果:使用呼吸机176人(有创168人,无创8人),共发生感染42例(有创41例,无创1例),其中有创97.62%,无创2.38%,VAP感染率为23.86%,有创VAP感染率为24.4%,无创VAP感染率为12.5%;感染以革兰阴性菌为主,占85.71%,代表菌属为鲍曼不动杆菌、克雷伯菌、铜绿假单胞菌,其次为革兰阳性菌(9.53%),代表菌属为金黄色葡萄球菌,真菌(4.76%);VAP的高危因素主要有基础性疾病、高龄、住院时间过长、侵袭性操作、滥用抗生素。结论:神经内科ICU是VAP的高发科室,主要以有创呼吸机为主,VAP病原菌以革兰氏阴性菌为主,应积极治疗基础性疾病,严格无菌观念,减少侵袭性操作,合理使用抗菌药,缩短住院时间,预防和控制VAP的发生和发展。

Objective：To discuss the influential factors and intervention measures for patients with ventilator associated pneumonia（VAP）in neurological internal care unit. Methods：Totally 882 hospitalized patients with VAP in neurological internal care unit from January to December in 2013 were investigated by regression analysis method. VAP incidence,connection mode of ventilator,pathogen characteristics and high risk factors were analyzed. Results：The ventilator served for 176 cases（168 invasive cases and 8 noninvasive cases）. Infection occurred in 42 cases（41 invasive cases and 1 noninvasive case）and VAP infection rate was 23.86%. Gram-negative bacteria（85.71%） made up most part of the infection including bauman acinetobacter sp,klebsiella,pseudomonas aeruginosa.Gram-positive bacteria made up 9.53% of the infection including staphylococcus aureus and fungi（4.76%）. High risk factors of VAP were underlying diseases,long period of hospitalization,invasive operation,and antibiotics abuse. Conclusion：Neurological intensive care unit is a division with high incidence of VAP. VAP mainly occurs in patients using ventilator and VAP pathogens are dominated by gram negative bacteria. Active treatment of underlying diseases,strict aseptic concept,reducing of invasive operation,rational use of antimicrobial drugs,shortening of hospitalization duration should be conducted to prevent and control the incidence and development of VAP.