呼吸机相关肺炎的诊断进展

Progress in the Diagnosis of Ventilator-Associated Pneumonia

呼吸机相关肺炎(VAP)是指机械通气48h后至拔管后48h内出现的肺炎,是医院获得性肺炎的重要类型,其中机械通气≤4d内发生的肺炎为早发性VAP,≥5d者为晚发性VAP.虽然VAP的定义较为明确,但临床上对于VAP的准确诊断困难超过其他任何一种医院感染.通常将肺组织病理学显示和微生物学发现病原微生物且二者相一致认定为VAP诊断的金标准.该诊断标准需要创伤性检查,不易被患者和医生接受,在临床上应用有一定困难.文章对近年来VAP的诊断进展做一综述.

Ventilator-associated pneumonia(VAP)refers to pneumonia that occurs within 48 hours of mechanical ventilation(MV)and within 48 hours after extubation.It is an important type of hospital-acquired pneumonia.Pneumonia was early-onset VAP,and those who were≥5 days were late-onset VAP.Although the definition of VAP is clear,the clinical diagnosis of VAP is more difficult than any other type of nosocomial infection.Pulmonary histopathological findings and microbiological findings of pathogenic microorganisms are commonly identified as the gold standard for VAP diagnosis.The diagnostic criteria require traumatic examinations that are not easily accepted by patients and doctors,and have some difficulties in clinical application.This article reviews the recent progress in the diagnosis of VAP.