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目的观察机械通气并发呼吸机相关性肺炎(VAP),探讨其对患者预后影响和防治对策。方法对SICU科2009年1~10月收治的机械通气患者的临床资料进行整理分析。结果呼吸机相关性肺炎(VAP)发生率为39.4%,123例VAP患者中痰中细菌检出率为93.5%,其中革兰氏阳性菌(G+)17.2%,革兰氏阴性菌(G-)72.0%,霉菌10.7%;病死率为26.0%。结论VAP是机械通气患者病死率增加的一个重要原因,定期更换呼吸机管道、持续性声门下分泌物引流、尽量不使用抗酸剂以及胃肠促动力药物应用可预防VAP的发生。选择合理抗生素、争取早日脱机,避免多重耐药菌株生长是减少VAP病死率的有效措施。
Objective To observe the effect of mechanical ventilation on ventilator associated pneumonia (VAP) and its influence on the prognosis of patients and its prevention and treatment. Methods The clinical data of patients with mechanical ventilation admitted to SICU from January to October in 2009 were analyzed. Results The incidence of ventilator-associated pneumonia (VAP) was 39.4%. The sputum bacterial count rate was 93.5% in 123 patients with VAP, of which Gram-positive bacteria (G) 17.2%, Gram-negative bacteria ) 72.0%, mold 10.7%; case fatality rate was 26.0%. Conclusion VAP is an important cause of mortality in patients with mechanical ventilation. Regular replacement of ventilator ducts, continuous drainage of subglottic secretions, avoidance of antacids as much as possible and the use of gastrointestinal motility drugs can prevent the occurrence of VAP. Select reasonable antibiotics, strive for an off-line as soon as possible to avoid the growth of multi-drug resistant strains is an effective measure to reduce the mortality of VAP.