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目的探讨重症患者呼吸机相关性肺炎(VAP)的发病危险因素和预防策略。方法对医院2009年6月-2011年5月ICU收治的入科时无肺部感染且进行机械通气>48h患者的临床资料进行回顾性调查分析。结果 183例患者发生VAP83例,发生率45.4%,所有VAP患者共检出病原菌165株,其中革兰阴性杆菌最常见,占69.70%,革兰阴性杆菌中以乙酸钙鲍氏复合不动杆菌最多,占39.39%;其他病原菌革兰阳性球菌占25.45%和真菌占4.85%;年龄≥60岁、机械通气时间≥5d、意识障碍、曾使用制酸剂、白蛋白<30g和侵入性操作为VAP发生的危险因素。结论重症患者VAP的发生与上述危险因素有关,应采取严密监控、规范洗手、加强保护性护理、严格呼吸道管理、改进营养支持方法等针对性的非药物干预措施,以减少VAP的发生。
Objective To explore the risk factors and preventive strategies of ventilator-associated pneumonia (VAP) in critically ill patients. Methods The clinical data of patients admitted to ICU from June 2009 to May 2011 admitted to our department without pneumonia and undergoing mechanical ventilation> 48h were analyzed retrospectively. Results A total of 183 cases of VAP occurred in 183 patients (45.4%). A total of 165 pathogenic bacteria were detected in all VAP patients, of which Gram-negative bacilli were the most common (69.70%), Acinetobacter baumannii , Accounting for 39.39%; other pathogens Gram-positive cocci accounted for 25.45% and fungi accounted for 4.85%; age ≥ 60 years, mechanical ventilation ≥ 5d, disturbance of consciousness, had the use of antacids, albumin <30g and invasive operation for the VAP Risk factors that occur. Conclusions The occurrence of VAP in critically ill patients is related to the above risk factors. Specific non-drug interventions such as strict monitoring, standard hand washing, intensive nursing care, strict respiratory management, and improved nutritional support should be taken to reduce the occurrence of VAP.