摘要
目的调查呼吸机相关性肺炎(VAP)发生的危险因素,探讨相应的护理对策。方法回顾性分析226例行机械通气患者VAP发生率、病原菌特点、相关危险因素及护理措施,总结预防和控制VAP的有效护理干预对策。结果 226例行机械通气患者发生VAP 49例,发生率为21.7%,随年龄增长VAP发病率逐渐上升(P<0.05);基础疾病中慢性阻塞性肺疾病(COPD)并发VAP 20例,发生率40.8%;通气时间>15d患者VAP发生率明显增高(P<0.05);VAP患者共检出病原菌114株,革兰阴性菌占65.4%,革兰阳性菌占24.0%,真菌10.6%;鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌是VAP主要致病菌;机械通气、原发基础疾病、抗菌药物不合理使用等因素是VAP的重要危险因素。结论 VAP发生与危险因素存在密切相关;严格护理操作,加强对危险因素控制及护理干预,减少VAP发生率。
OBJECTIVE To explore the risk factors and nursing strategies of ventilator-associated pneumonia （VAP）. METHODS The incidence of VAP, risk factors, characteristics of pathogens and effective nursing strategies were investigated through retrospective analysis of 226 patients who underwent the mechanical ventilation. RESULTS There were 226 patients investigated and 49 patients diagnosed as the VAP with the incidence rate of 21.7%. The incidence of VAP was increased along with the age growing （P^0.05）. Among the patients with underlying diseases, the VAP occurred in 20 cases of patients complicated with COPD with the incidence rate of 40.8% ; the incidence rate of the VAP in the patients with the mechanical ventilation duration more than 15 days was significantly elevated （P〈0.05）. A total of 114 strains of pathogens were isolated from the VAP patients , the main pathogens included the gram-negative bacteria（65. 4%）, gram-positive bacteria （24.0%） and fungi（ 10.6 %）. The Acinetobacter baumannii, Pseudornonas aeruginosa, Staghylococcus aureusme-thicillin, and Klebsiella pneumoniae were the predominant species of pathogens causing VAP. The mechanical ventilation, primary disease, and inappropriate use of antibiotics were the risk factors of VAP. CONCLUSION The incidence of VAP is closely related to the risk factors; the strict nursing operation and the intensified control of the risk factors and the nursing interventions can contribute to the reduction of incidence of VAP.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第11期2542-2544,共3页
Chinese Journal of Nosocomiology
关键词
呼吸机相关性肺炎
危险因素
护理对策
Ventilator-associated pneumonia
Risk factor
Nursing strategy
