ICU呼吸机相关肺炎防治的临床研究  

Clinical Research on Ventilator-associated Pneumonia in ICU

作　　者：周荣兵 

机构地区：[1]山东省广饶县人民医院重症医学科,山东广饶257300

出　　处：《中国医药指南》2013年第7期420-421,共2页Guide of China Medicine

摘　　要：目的探讨重症加强治疗病房(Intensive Care Unit,ICU)呼吸机相关肺炎(ventilator-associated pneumonia,VAP)的发病机制、易感致病因素及防护措施。方法回顾性分析本院ICU收治的112例呼吸机使用患者,收集患者临床详细资料,同时收集患者的口咽部、声门下分泌物、呼吸道痰液以及胃液进行培养和药敏检测,分析VAP的病源和危险因素,探讨其防治措施。结果 VAP患者的病原菌主要为G-菌,年龄、患者身体素质、呼吸机持续时间、口腔洁净度、鼻胃管是否滞留、糖皮质激素、制酸剂、抗菌药物的使用等为其易感因素。结论菌群易位或比例失调是VAP发病的主要机制,胃-咽-下呼吸道的逆行感染为VAP的重要感染途径,此外,还受患者年龄、体质及药物使用等影响,可以通过调控其易感因素有效控制VAP的发病率。Objective To investigate the pathogenesis, pathogenic factors, and protective measures of Ventilator-associated Pneumonia in ICU. Methods Study on 112 patients with VAP in ICU, collected their age, sex, duration of ventilation, surgery and medication; then collected the secretions of oropharyngeal and subglottic, respiratory mucus and gastric juice with a quantitative method cultured and their antibiotic susceptibility was detected. Analysed the source of the disease and risk factors of VAP, and its prevention measures. Results Pathogenic bacteria of VAP in ICU mostly were G-, the predisposing factors were age, the physical of Patients, ventilator duration, oral cleanliness, nasogastric tube is stranded, corticosteroids, antacids, use of antimicrobial drugs. Conclusion The pathogenesis of VAP is bacterial translocation or imbalance, the important route of infection is retrograde infection of stomach - pharynx - the lower respiratory tract. In addition, the patient＇s age, physical fitness, and drug use are influencing factors. By regulating the predisposing factors to effectively control the incidence of VAP.

关 键 词：ICU 呼吸机相关肺炎 防治 

分 类 号：R563.19[医药卫生—呼吸系统]