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Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome 被引量:9
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作者 Antonio Siniscalchi Lucia Aurini +4 位作者 Beatrice Benini Lorenzo Gamberini Stefano Nava Pierluigi Viale Stefano Faenza 《World Journal of Transplantation》 2016年第2期389-395,共7页
AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242... AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development. 展开更多
关键词 Liver TRANSPLANTATION ventilator associated pneumonia PERIOPERATIVE period Infection
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Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis 被引量:17
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作者 Suresh Kumar Arumugam Insolvisagan Mudali +3 位作者 Gustav Strandvik Ayman El-Menyar Ammar Al-Hassani Hassan Al-Thani1 《World Journal of Emergency Medicine》 SCIE CAS 2018年第3期203-210,共8页
BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed fo... BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role. 展开更多
关键词 ventilator-associated pneumonia TRAUMA Mechanical ventilation INTUBATION location INTENSIVE care unit
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Subglottic Secretion Drainage for Preventing Ventilator Associated Pneumonia: A Meta-analysis 被引量:2
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作者 Rong Wang Xiang Zhen +3 位作者 Bao-Yi Yang Xue-Zhen Guo Xue Zeng Chun-Yan Deng 《Chinese Nursing Research》 CAS 2015年第3期133-140,共8页
Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the i... Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk (RR) =0.52, 95% confidence interval (C/): 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84-1.19) and for hospital mortality was 0.95 (95% CI, 0. 80-1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days (95% CI, -2.94 to -0.11) and on the ICU length of stay (LOS) was -0.81days (95% CI, -2.33 to -0.7). Conclusions: In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials, 展开更多
关键词 Intensive care unit Mechanical ventilation ventilator associated pneumonia META-ANALYSIS
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The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients 被引量:7
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作者 Ashraf Abd El Halim Adel Attia +1 位作者 Taysser Zytoun Hosam Eldeen Salah 《Open Journal of Respiratory Diseases》 2013年第2期73-78,共6页
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality... Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings. 展开更多
关键词 ventilator-associated pneumonia (vap) PROCALCITONIN (PCT) Acute Physiology and Chronic Health Evaluation II (APACHE II) The Sequential ORGAN Failure Assessment SCORE (SOFA) Clinical Pulmonary Infection SCORE (CPIS)
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Pseudomonas aeruginosa ventilator associated pneumonia: improved outcomes with earlier follow-up
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作者 Elpis Giantsou Nikolaos Liratzopoulos +2 位作者 Eleni Efraimidou Konstantinos I. Manolas J. Duncan Young 《Health》 2010年第2期82-89,共8页
It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment.... It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up. 展开更多
关键词 ventilator-associated pneumonia Clinical Pulmonary Infection Score PSEUDOMONAS AERUGINOSA
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Ventilator Associated Pneumonia in an Intensive Care Unit
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作者 Yadigar Yilmaz Camgoz Ferda Yilmaz İnal Öznur Şen 《Open Journal of Respiratory Diseases》 2022年第2期44-55,共12页
The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mech... The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken. 展开更多
关键词 ventilator associated pneumonia Mechanical ventilation Intensive Care Unit
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Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients
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作者 Yuxiu Lei Jana Hudcova +7 位作者 Jawad Rashid Akmal Sarwar Wendy Gillespie Carol Finn Marie Goggin Mohamed B. Omran Edward Boroda Donald E. Craven 《Modern Research in Inflammation》 2016年第1期1-11,共11页
We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventil... We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration. 展开更多
关键词 ventilator-associated Tracheobronchitis (VAT) and pneumonia (vap) Bacterial Pathogens Semi-Quantitative Endotracheal Aspirate (SQ-ETA) Cultures Antibiotic Therapy
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不同抗生素联合替加环素治疗MDRAB相关VAP患者效果比较
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作者 石新艳 尚宁 +4 位作者 王虹 杨婷婷 赵春玲 齐卫卫 刘伟 《精准医学杂志》 2024年第5期431-434,共4页
目的探讨不同抗菌药物联合替加环素治疗多重耐药鲍曼不动杆菌(MDRAB)相关呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的效果,旨在为临床上更好治疗该病提供方案选择。方法收集2016年1月—2023年8月青岛市市立医院收治的... 目的探讨不同抗菌药物联合替加环素治疗多重耐药鲍曼不动杆菌(MDRAB)相关呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的效果,旨在为临床上更好治疗该病提供方案选择。方法收集2016年1月—2023年8月青岛市市立医院收治的MDRAB相关VAP患者的临床资料,根据治疗方案不同分为替加环素组(A组)56例,头孢哌酮舒巴坦联合治疗组(B组)42例,碳青霉烯类联合治疗组(C组)24例,对三组患者住院期间感染情况及各项疗效指标进行比较。结果三组MDRAB相关VAP感染患者间感染病原体的种类、合并感染部位比较差异均无显著性(P>0.05),B组和C组细菌清除率高于A组(χ^(2)=5.38、4.48,P<0.05),三组患者住院病死率比较差异无显著性(P>0.05)。结论替加环素联合头孢哌酮舒巴坦或碳青酶烯类抗菌药物治疗MDRAB相关VAP的细菌清除率均显著高于单独使用替加环素,联合用药是一种比较好的治疗选择。 展开更多
关键词 替加环素 肺炎 呼吸机相关性 鲍氏不动杆菌 抗药性 细菌 疗效比较研究
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气道湿化联合口腔护理在预防急危重症患者呼吸机辅助通气中VAP发生的作用
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作者 邹丽琴 《中国医药指南》 2024年第20期41-43,共3页
目的探讨气道湿化联合口腔护理在预防急危重症患者呼吸机辅助通气中呼吸机相关肺炎(VAP)发生的作用。方法选取我院收治的300例急危重症行呼吸机辅助通气患者为对象,样本病例纳入时间为2021年7月至2023年7月,采取1∶1比例法分组,均分为15... 目的探讨气道湿化联合口腔护理在预防急危重症患者呼吸机辅助通气中呼吸机相关肺炎(VAP)发生的作用。方法选取我院收治的300例急危重症行呼吸机辅助通气患者为对象,样本病例纳入时间为2021年7月至2023年7月,采取1∶1比例法分组,均分为150例,对照组给予常规护理干预,观察组在常规护理基础上给予气道湿化联合口腔护理。对比两组口腔清洁度、炎症指标、VAP发生率、相关治疗时间、护理认可度。结果观察组患者口腔清洁度优于对照组(P<0.05);观察组白细胞计数、降钙素原及C反应蛋白指标以及VAP总发生率均低于对照组(均P<0.05);观察组呼吸机使用时间、住重症监护室时间及总住院时间均短于对照组,患者护理工作认可度评分高于对照组(均P<0.05)。结论在预防急危重症患者呼吸机辅助通气中应用气道湿化联合口腔护理,可有效提升护理干预效率,保障患者口腔卫生清洁,利于改善机体炎症指标、减少VAP发生,进而有效缩短相关治疗及通气时间。 展开更多
关键词 急危重症 呼吸机辅助通气 气道湿化 联合口腔护理 呼吸机相关肺炎
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某医院ICU老年患者VAP病原菌检测及药敏结果分析
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作者 郭庆利 王斌 钱冬萌 《航空航天医学杂志》 2024年第1期15-18,共4页
目的 探究重症监护室(ICU)患者呼吸机相关性肺炎(VAP)病原菌的分布情况以及相关药敏试验情况,为后续为患者制定有效且针对性控制措施提供依据。方法 选择本医院2020年04月-2023年04月ICU呼吸机相关性肺炎患者51例作为研究对象,对其痰液... 目的 探究重症监护室(ICU)患者呼吸机相关性肺炎(VAP)病原菌的分布情况以及相关药敏试验情况,为后续为患者制定有效且针对性控制措施提供依据。方法 选择本医院2020年04月-2023年04月ICU呼吸机相关性肺炎患者51例作为研究对象,对其痰液标本展开病原菌检测以及相关药敏检测,并对其病原菌的分布情况以及相关药敏结果进行统计分析。结果 在51例重症监护室VAP患者中共分离出78株病原菌,其中,革兰阴性菌有59株(75.64%),居前5位的依次为鲍曼不动杆菌,肺炎克雷伯菌,铜绿假单胞,大肠埃希菌,阴沟肠杆菌;革兰阳性菌有5株(6.41%),占比最高的是金黄色葡萄球菌有4株(80.00%);以及真菌共有14株(17.95%)。对于肺炎克雷伯菌而言,常用的抗生素可选择哌拉西林/他唑巴坦复方制剂、头孢唑林、头孢他啶;鲍氏不动杆菌对多数抗生素均有较高的耐药性,其中排首位的为美罗培南(84.21%)、其次为左氧氟沙星、环丙沙星、氨苄西林/舒巴坦、头孢吡肟和头孢他啶,均占73.68%;铜绿假单胞菌对亚胺培南、美罗培南耐药性相较而言较高;大肠埃希菌对大部分抗生素均有较好的耐药性,如头孢类药物,其耐药性可高达100%,金黄色葡萄球菌对青霉素、克林霉素具有一定的耐药性。结论 在重症监护室呼吸机相关性肺炎病原菌中占比最高的为革兰阴性菌鲍曼不动杆菌,其对多数药物均有较高的耐药性,各个病原菌对抗生素的耐药性不同,临床应当根据病原菌检测的药敏结果为患者选择合适的抗生素予以治疗,以保证患者病情稳定,促进其恢复。 展开更多
关键词 重症监护室 呼吸机相关性肺炎 病原菌检测 药敏结果
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血清VEGF和Fn对VAP患者预后不良的预测价值
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作者 齐连振 郭会莉 +1 位作者 林庆华 柴瑞丽 《检验医学与临床》 CAS 2024年第18期2711-2716,2723,共7页
目的探讨血清血管内皮生长因子(VEGF)和黏连蛋白(Fn)在不同时间对呼吸机相关肺炎(VAP)患者预后不良的预测价值。方法回顾性分析2020年1月至2023年12月在邢台医学高等专科学校第二附属医院就诊的242例VAP患者的病历资料。记录患者入院第1... 目的探讨血清血管内皮生长因子(VEGF)和黏连蛋白(Fn)在不同时间对呼吸机相关肺炎(VAP)患者预后不良的预测价值。方法回顾性分析2020年1月至2023年12月在邢台医学高等专科学校第二附属医院就诊的242例VAP患者的病历资料。记录患者入院第1、3、5天血清VEGF、Fn水平,根据急性生理学和慢性健康状况(APACHE)Ⅱ评分将所有患者分成低危组(<10分)、中危组(10~20分)和高危组(>20分)。在患者出院28 d后进行随访,根据生存情况分为存活组与死亡组。采用Pearson相关分析VAP患者入院第3、5天血清VEGF、Fn水平与APACHEⅡ评分的相关性。采用多因素Logistic回归分析VAP患预后不良的危险因素。绘制受试者工作特征(ROC)曲线分析血清VEGF、Fn对VAP患者死亡的预测价值。结果低、中、高危组的患者分别有84、101、57例。中、高危组不同时间VEGF水平比较结果显示,入院第1天<入院第3天<入院第5天(P<0.05)。多变量方差分析结果显示,入院第3、5天高危组VEGF水平高于中危组和低危组(F=36.075、43.523,P<0.05)。低、中危组不同时间Fn水平比较结果显示,入院第1天<入院第3天<入院第5天(P<0.05)。入院第3、5天高危组Fn水平低于中危组和低危组(F=19.907、60.326,P<0.05)。入院第3、5天血清VEGF水平分别与APACHEⅡ评分呈正相关(r=0.433、0.519,P<0.001),入院第3、5天血清Fn水平分别与APACHEⅡ评分呈负相关(r=-0.384、-0.602,P<0.001)。存活组和死亡组分别有171、71例患者。死亡组和存活组APACHEⅡ评分、低密度脂蛋白、高密度脂蛋白水平比较,差异均有统计学意义(P<0.05)。死亡组不同时间VEGF水平比较结果显示,入院第1天<入院第3天(P<0.05)。多变量方差分析结果显示,入院第3、5天死亡组VEGF水平高于存活组(F=11.034、10.245,P<0.05)。存活组和死亡组不同时间Fn水平比较结果显示,入院第1天<入院第3天(P<0.05)。入院第3、5天死亡组Fn水平低于存活组(F=6.504、7.933,P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分升高、入院第3、5天血清VEG水平升高,入院第3、5天Fn水平降低是VAP患者死亡的危险因素(P<0.05)。ROC曲线分析结果显示,入院第3、5天血清VEGF及Fn联合预测VAP患者死亡的曲线下面积为0.879。结论血清VEGF、Fn水平与VAP患者病情严重程度有关,并可预测VAP患者死亡,二者在进行临床实践前,还需做更多试验证明其在VAP中的作用。 展开更多
关键词 血管内皮生长因子 黏连蛋白 呼吸机相关肺炎 病情严重程度 预后
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辅助通气治疗的RDS早产儿发生VAP的危险因素
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作者 王丽琼 王琦凡 张雅迪 《包头医学院学报》 CAS 2024年第9期52-55,共4页
目的:探究辅助通气治疗的呼吸窘迫综合征(RDS)早产儿发生呼吸机相关性肺炎(VAP)的危险因素。方法:选择2020年5月至2022年5月于泉州市第一医院接受辅助通气治疗的RDS早产儿100例为观察目标,统计辅助通气期间VAP发生率,按照有无VAP发生分... 目的:探究辅助通气治疗的呼吸窘迫综合征(RDS)早产儿发生呼吸机相关性肺炎(VAP)的危险因素。方法:选择2020年5月至2022年5月于泉州市第一医院接受辅助通气治疗的RDS早产儿100例为观察目标,统计辅助通气期间VAP发生率,按照有无VAP发生分成VAP组和无VAP组,通过单因素与多因素Logistic回归分析法对RDS早产儿辅助通气期间VAP发生危险因素予以分析。结果:100例RDS早产儿在辅助通气治疗期间发生VAP者34例、未发生VAP者66例,VAP发生率是34%(34/100);单因素分析显示,VAP组早产儿的有创机械通气治疗时间、拔管后无创通气治疗时间、新生儿窒息率、新生儿抢救率、重复插管上机治疗次数均高于无VAP组,差异有统计学意义(P<0.05);多元Logistic回归分析显示,有创机械通气治疗时间、拔管后无创通气治疗时间、新生儿窒息、新生儿抢救、重复插管上机治疗次数>3次为RDS早产儿辅助通气治疗期间VAP发生的独立危险因素(P<0.05)。结论:RDS早产儿辅助通气期间受机械通气治疗时间、新生儿窒息及重复插管上机治疗次数等因素影响,存在较高的VAP发生可能性。 展开更多
关键词 早产儿 呼吸窘迫综合征 辅助通气 呼吸机相关性肺炎 危险因素
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MSCs通过抑制PI3K/Akt信号通路减轻VAP肺损伤的作用研究
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作者 朱建秋 罗幸 +1 位作者 谢迎秋 主有峰 《国际医药卫生导报》 2024年第4期597-601,共5页
目的呼吸机相关性肺炎(VAP)是机械通气患者最常见的感染性疾病,严重影响重症患者的预后,但其发病机制目前仍未完全清晰。本文针对VAP发生时,间充质干细胞(MSCs)对肺泡上皮细胞的炎症反应的影响进行研究。方法本研究实施于2020年5月至202... 目的呼吸机相关性肺炎(VAP)是机械通气患者最常见的感染性疾病,严重影响重症患者的预后,但其发病机制目前仍未完全清晰。本文针对VAP发生时,间充质干细胞(MSCs)对肺泡上皮细胞的炎症反应的影响进行研究。方法本研究实施于2020年5月至2023年3月。本研究建立VAP大鼠动物模型并提取、鉴定MSCs,取SPF级健康雄性大鼠15只,体质量180~200 g,随机分为空白对照组、VAP组和VAP+MSCs组。空白对照组、VAP组的肺泡上皮细胞单独在培养箱内培养,VAP+MSCs组的肺泡上皮细胞与MSCs在培养箱内共培养,48 h后通过实时荧光定量核酸扩增检测系统(qPCR)及酶联免疫吸附法(ELISA)检测3组磷脂酰肌醇3-激酶(PI3K)、丝氨酸/苏氨酸蛋白激酶(Akt)以及下游炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素1α(IL-1α)、γ-干扰素(IFN-γ)]的表达情况。采用独立样本t检验、单因素方差分析。结果qPCR及ELISA检测结果显示空白对照组PI3K、Akt以及下游炎症因子TNF-α、IL-1α、IFN-γ表达水平最低;VAP组PI3K、Akt以及下游炎症因子TNF-α、IL-1α、IFN-γmRNA表达水平最高,高于另外两组;而VAP+MSCs组炎症因子水平虽高于空白对照组,但较VAP组下降,差异均有统计学意义(均P<0.05)。结论在VAP发生过程中MSCs可能通过抑制PI3K/Akt信号通路抑制肺泡上皮细胞炎症因子表达,从而达到抑制或减轻VAP的作用。 展开更多
关键词 呼吸机相关性肺炎 间充质干细胞 肺损伤 PI3K/AKT 动物实验
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机械通气患儿VAP的病原菌分布特征及炎性因子监测的价值
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作者 刘诗吟 王芳 《临床医学工程》 2024年第10期1255-1256,共2页
目的探讨机械通气患儿呼吸机相关肺炎(VAP)的病原菌分布特征及炎性因子监测的价值。方法270例接受机械通气的患儿根据VAP发生情况分为VAP组和非VAP组,比较两组的炎性因子水平。记录VAP患儿的病原菌检出情况,分析病原菌分布情况及耐药率... 目的探讨机械通气患儿呼吸机相关肺炎(VAP)的病原菌分布特征及炎性因子监测的价值。方法270例接受机械通气的患儿根据VAP发生情况分为VAP组和非VAP组,比较两组的炎性因子水平。记录VAP患儿的病原菌检出情况,分析病原菌分布情况及耐药率。结果172例VAP患儿共培养分离出205株病原菌,其中144株为革兰阴性菌,57株为革兰阳性菌,4株真菌。肺炎克雷伯菌、铜绿假单胞菌均对庆大霉素的耐药率最高,对亚胺培南、美罗培南的敏感性较高。VAP组的PCT、CRP、IL-6、IL-10、TNF-α水平均高于非VAP组(P<0.05)。结论机械通气患儿VAP的感染病原菌主要为革兰阴性菌,临床早期治疗可选用革兰阴性菌敏感性药物,监测炎性因子表达情况有助于早期预测VAP的发生。 展开更多
关键词 机械通气 呼吸机相关肺炎 病原菌 炎性因子
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盐酸氨溴索联合替考拉宁治疗ICU革兰阳性菌感染VAP患者的效果
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作者 陈亚飞 《中外医学研究》 2024年第6期48-51,共4页
目的:探讨盐酸氨溴索联合替考拉宁治疗重症监护病房(Intensive Care Unit,ICU)革兰阳性菌感染呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者的效果。方法:选取2019年1月—2020年12月贵航贵阳医院收治的120例ICU革兰阳性... 目的:探讨盐酸氨溴索联合替考拉宁治疗重症监护病房(Intensive Care Unit,ICU)革兰阳性菌感染呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者的效果。方法:选取2019年1月—2020年12月贵航贵阳医院收治的120例ICU革兰阳性菌感染VAP患者。根据随机数表法将其分为对照组和观察组,各60例。对照组给予常规抗感染治疗,观察组在对照组基础上给予盐酸氨溴索联合替考拉宁治疗。比较两组临床疗效,相关指标,不良反应,治疗前后免疫指标。结果:观察组总有效率为93.33%,显著高于对照组的76.67%,差异有统计学意义(P<0.05)。观察组恢复时间、住院时间均短于对照组,总费用少于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平显著高于治疗前及对照组,CD8^(+)水平显著低于治疗前及对照组,差异有统计学意义(P<0.05)。结论:盐酸氨溴索联合替考拉宁能够提高ICU革兰阳性菌感染VAP患者的临床疗效,缩短恢复时间及住院时间,降低费用,同时能够增强机体免疫功能,调节T淋巴细胞亚群水平,具有较好的安全性和耐受性。 展开更多
关键词 盐酸氨溴索 替考拉宁 革兰阳性菌 呼吸机相关性肺炎 T淋巴细胞亚群
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脑出血术后合并VAP患者肺多重耐药菌感染的危险因素分析
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作者 陈世霖 周敏 《中国现代医生》 2024年第27期52-56,共5页
目的分析脑出血术后合并呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者发生肺部多重耐药菌(multiple drug-resistant organism,MDRO)感染的危险因素及病原学特点。方法回顾性分析2020年1月至2022年1月于安徽医科大学附属... 目的分析脑出血术后合并呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者发生肺部多重耐药菌(multiple drug-resistant organism,MDRO)感染的危险因素及病原学特点。方法回顾性分析2020年1月至2022年1月于安徽医科大学附属省立医院神经重症科收治的103例脑出血术后合并VAP患者。收集患者的年龄、性别、总住院时间、基础疾病、术前格拉斯哥昏迷评分(Glasgow coma score,GCS)、手术类型、手术时间等资料。根据病原菌是否为MDRO将患者分为MDRO感染组(n=42)与非MDRO感染组(n=61)。采用二项Logistic回归分析探讨MDRO感染的相关危险因素。结果Logistic回归分析结果表明,总住院时间、二次手术为MDRO的独立危险因素(P<0.05)。在103例患者的痰培养标本中,检出并统计病原菌103株,其中MDRO 42株(40.78%),包含鲍曼不动杆菌17株(40.48%)、金黄色葡萄球菌11株(26.20%)、铜绿假单胞菌5株(11.90%)、洋葱伯克霍尔德菌4株(9.52%)、肺炎克雷伯杆菌3株(7.14%)、肺炎链球菌1株(2.38%)、阴沟肠杆菌复合菌1株(2.38%)。结论脑出血术后合并VAP患者的总住院时间越长,MDRO感染的风险越高。二次手术患者的MDRO风险显著高于未做二次手术的患者。鲍曼不动杆菌等是常见的MDRO。 展开更多
关键词 脑出血 呼吸机相关性肺炎 多重耐药菌 术后 危险因素
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基于前馈风险控制理论下的精细化护理对小儿VAP临床指标及预后的影响分析
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作者 付存玉 崔云 《全科护理》 2024年第11期2055-2058,共4页
目的:探讨对呼吸机相关性肺炎(VAP)患儿实施基于前馈风险控制理论的精细化护理的临床价值。方法:病例选取开封市儿童医院2020年3月—2022年3月103例VAP患儿为研究对象,采用随机数字表法分为对照组(51例)与研究组(52例),研究组接受基于... 目的:探讨对呼吸机相关性肺炎(VAP)患儿实施基于前馈风险控制理论的精细化护理的临床价值。方法:病例选取开封市儿童医院2020年3月—2022年3月103例VAP患儿为研究对象,采用随机数字表法分为对照组(51例)与研究组(52例),研究组接受基于前馈风险控制理论的精细化护理,对照组接受常规护理。比较两组的儿童状态-特质焦虑量表(STAIC)评分、血清降钙素原(PCT)、儿童抑郁评定量表(CDRS)评分、血清淀粉样蛋白(SAA)、临床症状改善时间及治疗依从性。结果:干预后研究组与对照组PCT(0.84±0.18 vs 1.21±0.22)ng/mL、STAIC(38.58±2.60 vs 35.26±3.58)分、SAA(7.26±0.22 vs 11.25±0.94)mg/L、CDRS(7.52±1.68 vs 15.48±2.17)分比较差异有统计学意义(P<0.05)。研究组与对照组咳嗽(3.74±0.51 vs 4.81±0.66)d、发热(1.50±0.37 vs 1.93±0.42)d、气促(2.08±0.70 vs 2.85±0.75)d、咳痰(3.51±0.64 vs 4.18±0.81)d改善时间比较差异有统计学意义(P<0.05),研究组与对照组治疗依从率(96.15%vs 80.39%)比较差异有统计学意义(P<0.05)。结论:基于循证理念的标准化护理可缩短支气管肺炎患儿身体康复时间,减轻患儿局部炎症反应,提高患儿治疗依从性。 展开更多
关键词 呼吸机相关性肺炎 儿童 前馈风险控制 精细化护理
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改良式巴氏刷牙法的冲洗式口腔护理在预防颅脑损伤VAP中的应用
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作者 左美云 张艳 +3 位作者 王海波 仲爱玲 戎捷骊 蔡萍 《循证护理》 2024年第4期671-675,共5页
目的:探讨改良式巴氏(Bass)刷牙法的冲洗式口腔护理在预防颅脑损伤呼吸机相关性肺炎(VAP)中的应用效果。方法:选取2022年5月—2023年2月南通大学附属海安人民医院外科重症加强护理病房(ICU)收治的90例经口气管插管机械通气的颅脑损伤病... 目的:探讨改良式巴氏(Bass)刷牙法的冲洗式口腔护理在预防颅脑损伤呼吸机相关性肺炎(VAP)中的应用效果。方法:选取2022年5月—2023年2月南通大学附属海安人民医院外科重症加强护理病房(ICU)收治的90例经口气管插管机械通气的颅脑损伤病人,按照随机数字表法分为对照组、观察组,每组45例。对照组采用棉球擦拭+冲洗式口腔护理,观察组采用改良式Bass刷牙法的冲洗式口腔护理。比较两组病人改良版Beck口腔评分、牙菌斑指数、口咽部细菌定植及VAP发生率。结果:改良版Beck口腔评分、牙菌斑指数经重复测量方差分析差异均有统计学意义(P<0.05),两组护理前、护理3 d、护理7 d改良版Beck口腔评分、牙菌斑指数均依次降低(P<0.05),护理3 d、护理7 d观察组改良版Beck口腔评分、牙菌斑指数均低于对照组(P<0.05);护理7 d观察组牙菌斑控制率高于对照组(P<0.05);两组护理前口咽部细菌定植阳性人数比较差异无统计学意义(P>0.05),观察组护理3 d、护理7 d的口咽部细菌定植阳性人数均少于护理前(P<0.05),观察组护理3 d、护理7 d的口咽部细菌定植阳性人数均少于对照组(P<0.05);观察组VAP发生率为4.44%,低于对照组的22.22%(P<0.05)。结论:改良式Bass刷牙法的冲洗式口腔护理可以改善经口气管插管机械通气颅脑损伤病人的口腔情况,减少牙菌斑及口咽部细菌定植阳性率,能够有效预防VAP的发生。 展开更多
关键词 改良式Bass刷牙法 冲洗式口腔护理 颅脑损伤 呼吸机相关性肺炎 护理
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VAP患者出现的原因以及个体化抗感染治疗研究进展
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作者 坑巍 《四川生理科学杂志》 2024年第7期1650-1652,共3页
通过总结文献资料,针对导致呼吸机相关性肺炎(Ventilator‐associated pneumonia,VAP)患者出现的原因进行分析,并重点分析VAP患者的个体化抗感染治疗研究进展,以期对相关疾病的治疗和研究提供参考。
关键词 呼吸机相关性肺炎 原因分析 个体化抗感染治疗
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不同气囊上滞留物冲洗间隔时间预防机械通气病人VAP的效果及其对气道菌群、气道黏膜损伤情况的影响
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作者 李向阳 李小玉 +3 位作者 陈香亚慧 杨利 徐月夏 杨喜庆 《全科护理》 2023年第13期1799-1801,共3页
目的:分析机械通气病人应用不同间隔时间冲洗气囊上滞留物预防呼吸机相关性肺炎(VAP)的效果及其对气道菌群、气道黏膜损伤情况的影响。方法:选取2020年9月—2022年2月郑州大学第一附属医院综合重症监护病区收治的91例气管插管行机械通... 目的:分析机械通气病人应用不同间隔时间冲洗气囊上滞留物预防呼吸机相关性肺炎(VAP)的效果及其对气道菌群、气道黏膜损伤情况的影响。方法:选取2020年9月—2022年2月郑州大学第一附属医院综合重症监护病区收治的91例气管插管行机械通气治疗的病人作为研究对象,依据随机数字表法分组。间隔长时间组45例给予间隔6 h对气囊上滞留物进行冲洗吸引,间隔短时间组46例给予间隔3 h对气囊上滞留物进行冲洗吸引。比较两组病人VAP发生情况、气道菌群株数、气道黏膜损伤情况。结果:干预后,间隔短时间组VAP发生时间短于间隔长时间组,VAP发生例数少于间隔长时间组(P<0.05);干预第7天,间隔短时间组真菌、革兰阳性菌、革兰阴性菌株数均少于间隔长时间组(P<0.05);两组病人气道黏膜肉眼可见出血、气囊上滞留物隐血发生率比较差异无统计学意义(P>0.05)。结论:间隔3 h、6 h对气囊上滞留物进行冲洗对病人气道黏膜损伤程度相当,但间隔3 h对气囊上滞留物进行冲洗吸引能够更加有效预防机械通气病人VAP发生,抑制气道菌群滋生,优于间隔6 h对气囊上滞留物进行冲洗吸引。 展开更多
关键词 气囊上滞留物 机械通气 呼吸机相关性肺炎 气道黏膜损伤 气道菌群 冲洗间隔时间
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