胸外科术后患者呼吸机相关性肺炎的危险因素与预防控制

Risk factors for postoperative ventilator-associated pneumonia in patients of thoracic surgery department and prevention and control measures

目的分析呼吸机相关性肺炎(VAP)的临床特征,为预防和控制VAP提供临床依据。方法回顾性分析2009年2月-2013年4月胸外科230例行机械通气患者的临床资料,采用SPSS12.0软件进行统计分析。结果 230例机械通气患者发生VAP 46例,在分离出的58株病原菌中革兰阴性菌占65.52%,革兰阳性菌占24.14%,真菌占10.34%;VAP的发病率与插管时间、气囊内压力、床头抬高、声门下分泌物吸引有关(P<0.05)。结论插管时间、气囊压力>20cm H2O、床头抬高≥30°、声门下分泌物吸引是降低VAP的主要因素,针对上述因素制定相应的预防干预措施,以降低VAP的发生。

OBJECTIVE To investigate the clinical characteristics of ventilator‐associated pneumonia （VAP） so as to provide guidance for prevention and control of VAP .METHODS The clinical data of 230 patients who underwent mechanical ventilation in the thoracic surgery department from Feb 2009 to Apr 2013 were retrospectively ana‐lyzed ,and the statistical analysis was performed by using SPSS12 .0 software .RESULTS The VAP occurred in 46 of 230 patients who underwent mechanical ventilation .Of the 58 strains of isolated pathogens ,65 .52% were the gram‐negative bacteria ,24 .14% were the gram‐positive bacteria ,and 10 .34% were the fungi .The prevalence of VAP was associated with the catheter indwelling time ,endotracheal cuff pressure ,elevation of the bed head ,and subglottic secretions aspiration （P〈0 .05） .CONCLUSION The catheter indwelling time ,endotracheal cuff pres‐sure more than 20 cmH2 O ,elevation of the bed head no less than 30＆#176; ,and subglottic secretions aspiration are the leading factors to reduce the incidence of VAP .It is necessary to take targeted interventions in response to the a‐bove factors so as to reduce the incidence of VAP .