三个时段感染防治措施对新生儿呼吸机相关肺炎干预效果  

Effectiveness of 3-period infection controlling strategies on neonatal ventilator-associated pneumonia

作　　者：周琦[1] 曹云[1] 蒋思远[1] 胡晓静[1] 陈超[1] 王传清[2] 

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102 [2]复旦大学附属儿科医院医院感染与控制科,上海201102

出　　处：《中国循证儿科杂志》2013年第4期262-266,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨NICU不同时段的防治措施对呼吸机相关肺炎(VAP)的效果,为临床提供有效的防治策略。方法以2008年6月复旦大学附属儿科医院搬迁至新院为分时段标志,第1时段:搬迁前1年,老医院NICU环境(防治措施:零散和经验性的),2006年2月1日至2007年1月31日;第2时段:搬迁后第1年,新医院NICU环境(防治措施:逐渐从单项防治措施向综合防治措施过渡),2008年8月1日至2009年7月31日;第3时段:搬迁后第2年,新医院NICU环境(防治措施:综合防治措施产生良性循环),2010年1月1日至2010年12月31日。以NICU使用气管插管呼吸机通气≥48h并在NICU住院时间≥5d的新生儿为研究对象,以VAP发生率为主要结局指标,比较3个时段VAP发生率和病原菌分布情况。结果 3个时段共入选491例新生儿,总的VAP发生率为27.3/1000呼吸机使用日。3个时段VAP发生率(/1000呼吸机使用日)分别为48.8、25.7和18.5,差异有统计学意义(P<0.001)。VAP病原菌以革兰阴性杆菌为主,占95.5%(63/66),最主要致病菌是鲍曼不动杆菌(65.2%,43/66);其次是肺炎克雷伯菌(15.2%,10/66);大肠埃希菌及铜绿假单胞菌各占6.1%(4/66)。结论 NICU环境改善的同时,逐步建立健全综合防治措施并形成良性循环能有效并且持续的降低VAP的发生率。Objective To investigate the effect of infection control strategies in three phases on the occurrence of ventilator- associated pneumonia （VAP） in a Chinese NICU, providing effective strategies for clinical practice. Methods The hospital was relocated at a new site from June 2008. Neonates who had been subjected to tracheal intubation-mechanical ventilation for ~〉48h and hospitalized by the newborn nursery for 〉I 5 d were included in this study. Three types of infection controlling strategies were corresponding to three time phases ~ controlling based on experience for phase 1, from Feb 1, 2006 to Jan 1,2007 ; single infection controlling strategy for phase 2, from Aug 1 2008 to Jul 31 2009; and comprehensive infection controlling strategy for phase 3, from Jan 1, 2010 to Dec 31, 2010. Related data were collected for comparing VAP incidence and pathogen distribution during three phases after a bundle of infection preventive measures were gradually implemented step by step. Results Totally 491 neonates were included and the overall incidence of VAP was 27.3 per 1 000 ventilator-days. The incidence of VAP was 48.8, 25.7 and 18.5 per 1 000 ventilator-days for the phase 1, 2 and 3, respectively. Gram-negative bacilli （63 strains, 95.5% ） were the primary VAP microorganisms in all phases, and the dominant organisms isolated for VAP during three periods were Acinetobacter baumannii（43 strians,65.2% ）, followed by Klebsiella pneumoniae （ 10 strains, 15.2% ）, Escherichia coli and Pseudomonas aemginosa （ 4 strains,6.1% in each）. Conclusion The improvement of NICU environment together with the adoption of the evidence-based muhi-faceted VAP control program could effectively reduce the occurrence of VAP with long-term effects, but the incidence was still high compared with the developed countries. Further studies are needed to improve the infection control strategies.

关 键 词：呼吸机相关肺炎 新生儿 感染控制 

分 类 号：R722.1[医药卫生—儿科]