3种消毒方法对呼吸机相关性肺炎的预防效果分析  

Effects of three different disinfection methods on prevention of ventilator-associated pneumonia

作　　者：宁波[1] 马宇洁[1] 张虎[2] 李一粟[1] 刘磊[1] 张红超[3] 

机构地区：[1]空军总医院重症医学科,北京100142 [2]空军总医院感染控制科,北京100142 [3]空军总医院心脏外科,北京100142

出　　处：《中华医院感染学杂志》2013年第21期5246-5248,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81270219)

摘　　要：目的分析比较实施3种消毒控制措施对重症监护病房(ICU)呼吸机相关性肺炎(VAP)预防效果,以控制VAP发生。方法选择2010年1月-2012年12月ICU所有机械通气≥5d患者797例,随机分为标准预防控制为对照组256例、应用75%乙醇强化消毒试验1组280例和三氯异氰尿酸强化消毒试验2组261例,3组均同时使用标准VAP预防策略,采用SPSS11.5软件进行统计分析,组间比较采用χ2检验,P<0.05为差异有统计学意义;采用WHONET5.4软件分析病原菌对抗菌药物的耐药率。结果 VAP发生率对照组为28.1%、试验1组为18.2%、试验2组为15.3%,试验1组及试验2组VAP发生率均显著低于对照组(P<0.05);检出铜绿假单胞菌及鲍氏不动杆菌对照组分别占23.6%及25.0%、试验1组分别占17.6%及41.2%、试验2组分别占42.5%及12.5%,试验1组与试验2组鲍氏不动杆菌、铜绿假单胞菌所占比例比较差异有统计学意义(P<0.05)。结论强化消毒控制措施可减少ICU VAP的发生率,预防VAP环境消毒时应根据致病菌流行病学特点选择适当的消毒剂。OBJECTIVE To analyze and compare the effects of three disinfection methods on the prevention of ventilator-associated pneumonia （VAP） in intensive care unit（ICU） so as to control VAP. METHODS Totally 797 cases of patients, who had received the mechanical ventilation for no less than 5 days in the ICU from Jan 2010 to Dec 2012, were enrolled in the study and randomly divided into the control group with 256 cases （the standard prevention and control）, the group 1 with 280 cases （use of 75% alcohol for strengthened sterilization）, and the group 2 with 261 cases （use of trichloroisocyanuric acid for strengthened disinfection）; the standard prevention strategies for VAP were implemented in all the three groups; the statistical analysis was performed with the use of SPSS 11. 5 software, the chi-square test was carried out for the comparison, with P〈0. 05 defined as the statistical significancel the drug resistance rates of pathogens were analyzed through WHONET 5. 4 software. RESULTS The incidencerate of VAP was 28. 1% in the control group, significantly higher than 18. 2% in the group 1 and 15.3% in the group 2, the difference was statistically significant（P〈0.05）. The isolation rate of Pseudomonas aeruginosa was 23.6% in the control group, 17.6% in the group 1, 42.5% in the group 2; while the isolation rate of the Acinetobacterbaumannii was 25.0% in the control group, 41.2% in the group 1, 12.5% in the group 2, the difference in the isolation rate of the P. aeruginosa or the A. baumannii between the group 1 and the group 2 was statistically significant （P〈0. 05）. CONCLUSION To enhance the implementation of the disinfection and prevention measures may reduce the incidence of VAP in the ICU; the appropriate disinfectants should be selected for environmental disinfection based on the epidemiologic characteristics of pathogens.

关 键 词：重症监护病房 呼吸机相关性肺炎 医院感染 预防 消毒 

分 类 号：R187[医药卫生—流行病学]