摘要
目的:认知导致呼吸机相关性肺炎(VAP)的危险因素,为预防和治疗VAP提供理论依据。方法:采用病例对照研究的方法,对190例接受机械通气支持的ICU患者的临床资料进行分析。结果:我院VAP的发生率为48.4%;高龄(>65岁)、机械通气时间过长(>5 d)、使用糖皮质激素、使用制酸药物、留置胃管、多种抗生素合用为VAP发生的危险因素;162株病原菌中,革兰阳性菌39株(24.07%),革兰阴性杆菌102株(62.96%),真菌21株(12.96%);多数病原菌存在多重耐药性。结论:多种因素与VAP的发生密切相关;病原菌分布以革兰阴性杆菌为主;菌株多重耐药性现象较普遍。采取对高龄患者加强监护,提高其免疫力;合理使用激素类药物;尽量缩短机械通气支持的时间,做好撤机计划;留置胃管及进行肠内营养支持的患者,抬高其床头、做好口腔清洁;医护人员在日常操作中严格遵循无菌原则,做好手部卫生,合理使用抗菌药物等措施可降低VAP的发生率。
OBJECTIVE: To analyze the risk factors, pathogens and drug sensitivity test of ventilator-associated pneumonia (VAP) in ICU. METHODS: A case-control study was conducted to analyze the clinical data of 190 patients receiving mechanical ventilatory support in ICU. RESULTS: The incidence of VAP in our hospital was 48.4 %; elderly patients (~65 years), duration of mechanical ventilation (〉 5 d), use of corticosteroids, antacid drugs, indwelling stomach tube, and combined use of antibiotics were the risk factors of VAP; among the 162 pathogens, 39 were Gram-positive bacteria (24.07 % ), 102 were Gram-negative bacte- ria (62.96%), 21 were fungi (12.96%); multi-drug resistance existed in most pathogens. CONCLUSIONS: A variety of factors are closely associated with the incidence of VAP; the main pathogens of VAP are Gram-negative bacteria; the phenomenon of multi-drug resistance is common. Some measures are adopted to decrease the incidence of VAP, such as strengthen monitoring of el- derly patients, to improve their immunity;use hormonal drugs reasonably; shorten the course of mechanical ventilation as much as possible, and plan ventilator removal; elevate the head of the bed and clean the oral for patients receiving gastric canal implantation and enteral nutrition;clean hands in accordance with asepsis principle strictly, and use antibacterials reasonalbly.
出处
《中国药房》
CAS
北大核心
2015年第20期2777-2779,共3页
China Pharmacy
关键词
呼吸机相关性肺炎
危险因素
病原菌
耐药性
Ventilator-associated pneumonia
Risk factor
Pathogen
Drug resistance