ICU呼吸机相关性肺炎的危险因素及防控措施

Analysis of risk factors of ICU ventilator-associated pneumonia and its prevention and control measures

目的研究重症监护室(ICU)呼吸机相关性肺炎的危险因素及防控措施。方法随机选取80例ICU呼吸机相关性肺炎感染患者设为观察组,同时选取未受ICU呼吸机相关性肺炎感染的80例患者设为对照组,采用回顾性分析方法对2组患者进行前瞻性对照研究,调查并分析研究对象的年龄、性别、白蛋白浓度、ICU呼吸机的使用时间及地点、糖皮质激素、抗酸剂、误吸、抗菌药物情况。结果观察组相关性肺炎患者的糖皮质激素、抗酸剂、抗菌药物的使用率以及误吸的发生率高于对照组(P<0.05);观察组相关性肺炎患者的年龄及呼吸机的使用时间均大于对照组,而白蛋白浓度低于对照组(P<0.05);观察组相关性肺炎患者在重症监护室插管的概率较高,而对照组在手术室插管的概率较高(P<0.05),2组在病房插管的比率差异无统计学意义(P>0.05)。结论 ICU呼吸机相关性肺炎与患者年龄大、白蛋白水平低、ICU呼吸机使用时间过长、糖皮质激素等药物使用不当、误吸因素及呼吸机的使用地点密切相关,临床应积极针对ICU呼吸机相关性肺炎的危险因素采取有效防控方法,以减少临床肺炎感染的发生。

Objective To study and analyze the risk factors and control measures of ICU ventilator-associated pneumonia. Methods A total of 2127 patients with ventilator-associated pneumonia in ICU were enrolled in the study group. At the same time,80 patients with ICU ventilator-associated pneumonia infection were selected as the control group. The retrospective analysis was used to carry out a prospective controlled study. The age,sex,concentration of albumin,the time and place of ICU ventilator application,glucocorticoid,antiacid,mistaken aspiration and antimicrobial agents were analyzed. Results The observation group had higher incidence rates of glucocorticoid,antacids,aspiration,antibiotics applications than the control group. The observation group had elder age and ventilator application time than the control group,while lower concentration of albumin（P〈0. 05）. The observation group had higher probability of intubation in ICU,while the control group had higher incidence of intubation in operation room（P〈0. 05）,but there were no significant difference in intubation in ward（P〉0. 05）. Conclusion ICU ventilator-associated pneumonia is closely related to patients＇ age,low albumin level,excessive duration of ventilator use,improper use of glucocorticoid and other drugs,false aspiration factors and the location of ventilator application. Therefore,we should take effective measures to reduce the incidence of clinical pneumonia by taking effective measures against the risk factors of ICU ventilator-associated pneumonia.