新生儿重症监护室呼吸机相关性肺炎研究进展

Research progress of ventilator-associated pneumonia in neonatal intensive care unit

呼吸机相关性肺炎(VAP)作为医院获得性肺部感染,在新生儿重症监护病房(NICU)中是重症患儿常见的并发症之一.但因新生儿VAP的定义尚无统一标准,且易与其他早产儿特有的肺部病理临床表现发生重叠,导致其诊断特异度较低,主观性较大.许多NICU实施了集束化预防策略,通过手卫生、口腔护理、设备无菌操作、每日评估是否可拔管及体位管理防止胃液反流等措施来减少VAP的发生,但需进一步证据来支持束元素的有效性.本文主要对新生儿VAP的流行病学、发病机制和预防措施等方面予以讨论与评估.

Ventilator-associated pneumonia(VAP),as a hospital-acquired pulmonary infection,is one of the com-mon complications in neonatal intensive care unit(NICU).However,there are no standardized cariteria for the definition of VAP in neonates,and it is prone to overlap with other clinical manifestations of pulmonary pathology specific to premature infants,resulting in low specificity and high subjectivity in the diagnosis.Many NICUs have implemented cluster prevention strategies to reduce the incidence of VAP through hand hygiene,oral care,aseptic operation of equipment,daily assessment of extubation,and body positioning to prevent gastric reflux,but further evidence is needed to support the effectiveness of cluster elements.This article mainly discusses and evaluates the epidemiology,pathogenesis and preventive measures of neonatal VAP.