呼吸机相关肺炎目标性监测研究进展  

Progress in targeted surveillance of ventilator-associated pneumonia

作　　者：林小芳 熊自超 丁明丽[1] LIN Xiao-fang;XIONG Zi-chao;DING Ming-li(Department of Infection Management,Ganzhou People's Hospital,Ganzhou,Jiangxi 341000)

机构地区：[1]赣州市人民医院感染管理科,江西赣州341000

出　　处：《赣南医学院学报》2024年第4期420-427,共8页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：赣州市科技局指导性科技计划项目(GZ2022ZSF157)。

摘　　要：呼吸机相关肺炎(Ventilator-associated pneumonia,VAP)是指机械通气48 h后至拔管后48 h内出现的肺炎,是医院获得性肺炎的重要类型。目前,VAP发病率较高,是医院感染防控的重点及难点,因此探索VAP目标性监测研究显得尤为重要。本文结合近年来国内外对VAP的研究文献,围绕VAP相关定义、发病机制、流行病学、病原菌及其耐药性、生物膜、危险因素、防控措施等方面进行综述。文献复习结果表明,VAP的主要发病机制是呼吸道及机体防御系统受损、机械通气时病原菌侵入及定植。引起VAP的病原菌通常以混合细菌感染为主,主要是革兰阴性菌。我国各级医院的VAP在病原菌分布及其耐药性情况差异较大。VAP的危险因素主要有:病原微生物定植、有创机械通气时间、高龄、急性生理与慢性健康Ⅱ评分(APACHEⅡ)高、血清白蛋白低、预防性使用抗菌药物、留置胃管、糖皮质激素的使用、使用抑酸剂、侵入性操作、使用镇静药物、床头未抬高30°~45°。VAP预防控制措施主要分为核心预防措施、一般预防措施、不常规或不推荐预防措施3类。这些结果表明,VAP的精准防控可针对不同的危险因素提出相对应的预防与控制措施,从而降低VAP发病率及病死率。Ventilator-associated pneumonia(VAP)is a major type of hospital-acquired pneumonia that occurs between 48 hours after mechanical ventilation and 48 h after extubation.At present,the high incidence of VAP is the focus and difficulty of nosocomial infection prevention and control.Therefore,it is particularly important to explore the progress of VAP targeted surveillance research.Based on the literature on VAP at home and abroad in recent years,this paper reviews the definition,pathogenesis,epidemiology,pathogenic bacteria and their drug resistance,biofilm,risk factors,prevention and control measures of VAP.The results of literature review show that the main pathogenesis of VAP is the damage of respiratory tract and body defense system,the invasion and colonization of pathogens during mechanical ventilation.The pathogens that cause VAP are usually mixed bacteria,mainly gram-negative bacteria.The distribution of pathogenic bacteria and drug resistance of VAP in different hospitals in China are quite different.The main risk factors of VAP are mainly colonization of pathogenic microorganisms,invasive mechanical ventilation time,old age,high acute physiological and chronic healthⅡscores(APACHEⅡ),low serum albumin,prophylactic use of antibiotics,indwelling gastric tube,use of glucocorticoids,use of acid suppressants,invasive operation,use of sedative drugs,the bedhead not raised by 30°-45°.VAP prevention and control measures are mainly divided into three categories:core preventive measures,general preventive measures,irregular or not recommended preventive measures.These results show that the accurate prevention and control of VAP can propose corresponding prevention and control measures according to different risk factors,so as to reduce the incidence and mortality of VAP.

关 键 词：呼吸机相关肺炎 危险因素 目标性监测 预防控制 

分 类 号：R563.1[医药卫生—呼吸系统]