呼吸机相关肺炎相关因素分析及综合干预措施的预防效果

Analysis of risk factors of ventilator associated pneumonia and comprehensive prevention measures for prevention of ventilator-associated pneumonia

目的探讨呼吸机相关肺炎(VAP)的相关因素及综合干预措施对其预防效果。方法回顾性分析2015年12月-2016年12月本院重症监护室(ICU)内进行机械通气超过48h的患者132例为研究对象,分为试验组和对照组,各66例,对照组患者进行常规治疗,试验组患者在常规治疗的基础上给予综合干预措施,观察两组患者的VAP发生率、机械通气时间及住ICU时间,归纳患者发生VAP的相关因素。结果 132例患者VAP发生率为42.42%(56/132),试验组发生VAP 12例少于对照组((P<0.001)),同时试验组患者机械通气时间及住ICU时间分别为(6.32±2.15)天及(10.23±2.13)天均低于对照组(P<0.05);意识障碍、低蛋白血症、使用糖皮质激素、脱机失败再次插管、机械通气时间、急性生理与慢性健康评分(APACHEⅡ)是患者VAP发生的相关因素(P<0.05)。结论 VAP的发生率较高,影响ICU患者VAP发生的因素较多,对机械通气患者给予综合干预措施能有效降低VAP发生率,减少患者机械通气时间及住ICU时间,具有一定临床价值。

OBJECTIVE To investigate the risk factors of ventilator associated pneumonia（VAP）and the preventive effects of comprehensive intervention measures on VAP.METHODS 132 patients who underwent mechanical ventilation for more than 48 hin the intensive care unit（ICU）of our hospital during Dec.2015 to Dec.2016 were enrolled and randomly divided into observation group and control group,with 66 cases in each group.The control group received routine treatment,and the observation group received comprehensive intervention measures on the basis of routine treatment.The incidence of VAP,mechanical ventilation time and ICU time were observed in the two groups,and the risk factors that might affect the occurrence of VAP were summarized.RESULTS The incidence of VAP in 132 patients was 42.42%（56/132）,and there were 12 cases of VAP in the experimental group,fewer than the control group（P〈0.001）.The time of mechanical ventilation and the time of living ICU were（6.32±2.15）days and（10.23±2.13）days respectively in the experimental group,which were both significantly lower than those of the control group（P〈0.05）.Consciousness disorder,hypoproteinemia,and use of corticosteroids,re-intubation after weaning failure,mechanical ventilation time,and APACHE-Ⅱ score significantly were related factors of VAP（P〈0.05）.CONCLUSION The incidence of VAP was relatively high,and the risk factors of VAP patients in ICU were diverse,.Comprehensive intervention measures can effectively reduce the incidence of VAP in patients with mechanical ventilation,decrease the duration of mechanical ventilation and ICU stay,and therefore have a certain clinical value.