小儿呼吸机相关肺炎防治策略研究  

Prevention strategy of ventilator-associated pneumonia in pediatrics

作　　者：安新江 张振坤 孙浩淼 刘晓鸣 王明光 

机构地区：[1]江苏省徐州市儿童医院ICU,徐州221006

出　　处：《临床医学》2008年第11期6-9,共4页Clinical Medicine

摘　　要：目的探讨小儿呼吸机相关肺炎(VAP)危险因素及防治策略。方法选取我院PICU及NICU机械通气患儿为研究对象,回顾性分析VAP发生的相关因素、VAP病原菌及药敏结果。结果278例入选研究病例发生VAP 108例,VAP发生率38.8%,其中新生儿VAP发生率44.9%。患儿年龄、血白蛋白浓度、抗生素使用时间、抗酸剂使用、静脉丙种球蛋白、激素、鼻饲、体位、重复气管插管以及机械通气参数吸气峰压(PIP)、呼气末正压(PEEP)等因素均与VAP发生有关。病原学以G-菌为主,前5位分别是铜绿假单胞菌、肺炎克雷白杆菌、鲍曼不动杆菌、大肠埃希菌、金黄色葡萄球菌。结论VAP发生与多种因素有关,其防治要采取综合措施。采取合理的通气策略减轻呼吸机相关性肺损伤(VILI),是降低VAP发病率的重要的一个方面。Objective To analyze the risk factors of ventilator associated pneumonia （VAP）, and to explore the relevant measures of prevention and treatment. Methods Children admitted to the PICU and NICU with mechanical ventilation were studied, and analysis was performed in correlation factors of VAP, pathogenic bacteria and their drug resistance. Results The incidence of VAP was 38.8% （ 108/278）, and among the total VAP, the incidence of neonate VAP was 44.9%. Age, density of albumin, time of antibiotic use, use of antacid, IVIG and corticosteroid, nasal feeding, body position, repeated tracheal intubation and parameters of mechanical ventilation （ PIP and PEEP） were significantly related to VAP. Tho major pathogenic bacteria was Gram - negative bacilli, and the most common pathogens associated with VAP were Pscudomonas aeruginosa, Bacillus canalis capsulatus, baumanii, Bacillus coli and Staphylococcus aureus. Conclusion Multiple risk factors relate to VAP, and the prevention and treatment requires a combined approach. Selecting reasonable ventilate measures to reduce VILI is important to a decreased incidence of VAP.

关 键 词：小儿 呼吸机相关肺炎 呼吸机相关性肺损伤 

分 类 号：R725.6[医药卫生—儿科]