2015-2018年某省158家医院ICU呼吸机相关肺炎监测分析  

Surveillance of ventilator-associated pneumonia in ICUs of 158 hospitals of a province from 2015 to 2018

作　　者：谢承峰 周治球 章新平 万小华[1] 罗晓黎[1] 陈强[2] 陈修文[1] XIE Cheng-feng;ZHOU Zhi-qiu;ZHANG Xin-ping;WAN Xiao-hua;LUO Xiao-li;CHEN Qiang;CHEN Xiu-wen(Jiangxi Provincial Children's Hospital Nanchang Jiangxi 330006, China)

机构地区：[1]江西省儿童医院医院感染管理科,江西南昌330006 [2]江西省儿童医院呼吸科,江西南昌330006

出　　处：《中华医院感染学杂志》2019年第13期2053-2057,共5页Chinese Journal of Nosocomiology

基　　金：江西省科技厅应用研究培育计划基金资助项目(20181BBG78012);江西省卫生计生委科技计划基金资助项目(20185434)

摘　　要：目的了解某省不同地域、性质及等级医院ICU呼吸机相关肺炎(VAP)发病情况及变化趋势。方法对2015-2018年158家省医院感染监控网医院ICU VAP进行目标性监测。结果 2015-2018年,VAP发生水平总体呈下降趋势。二级医院VAP千日感染率(20.17~8.66‰,M=11.95)高于三级医院(15.25~6.74‰,M=7.34)(Z=11.635,P<0.001)。不同性质医院中,综合性医院与中医院VAP发生水平无统计学差异(Z=0.615,P=0.539),与综合性医院相比,妇幼专科医院最低(3.65‰)(Z=-7.610,P<0.001),其他专科类医院最高(11.53‰)(Z=5.560,P<0.001)。赣北与赣南地区VAP发生水平无统计学差异(Z=1.747,P=0.081),赣中地区低于赣北地区(Z=-4.176,P<0.001),赣北与赣南地区VAP发生水平呈下降趋势(赣北χ^2=75.909,P<0.001;赣南χ^2=53.071,P<0.001)。ICU患者有创通气使用率与VAP发生水平无相关性(P>0.05)。结论持续加强ICU VAP的监控,并定期分析、反馈和查找高危因素,为采取针对性防控策略提供依据,可有效降低ICU VAP发病率。OBJECTIVE To understand the prevalence and trend of ventilator-associated pneumonia(VAP) in ICUs of hospitals of different regions, nature and grades in a province. METHODS A targeted surveillance was conducted for VAP in the ICUs of 158 hospitals through provincial hospital infection surveillance network from 2015 to 2018. RESULTS The overall incidence of VAP showed a downward trend from 2015 to 2018. The thousand-day infection rate was 20.17~8.66‰(M=11.95) in the secondary hospitals, significantly higher than 15.25~6.74‰(M=7.34)in the tertiary hospitals(Z=11.635,P<0.001). There was no significant difference in the incidence of VAP between the general hospitals and the TCM hospitals( Z=0.615,P=0.539);as compared with the general hospitals, the incidence of VAP was the lowest(3.65%) in the maternal and child hospitals(Z=-7.610,P<0.001) and was the highest(11.53%) in other specialist hospitals(Z=5.560,P<0.001). There was no significant difference in the incidence of VAP between the northern Jiangxi province and southern Jiangxi province(Z=1.747,P=0.081), the incidence of VAP was significantly lower in the middle Jiangxi province than in the northern Jiangxi province(Z=-4.176,P<0.001);the incidence of VAP showed a downward trend in the northern and southern Jiangxi province(northern Jiangxi province χ^2=75.909,P<0.001;southern Jiangxi province χ^2=53.071,P<0.001). The rate of invasive ventilation was not associated with the incidence of VAP(P>0.05). CONCLUSION It is an effective way to continuously strengthen the surveillance of VAP in ICUs, regularly analyze, feed back and find out high risk factors and take targeted prevention measures so as to reduce the incidence of VAP in ICUs.

关 键 词：重症监护病房 呼吸机相关肺炎 目标性监测 趋势 分析 

分 类 号：R563.1[医药卫生—呼吸系统]