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目的探讨ICU呼吸机相关性肺炎(VAP)的发病原因和干预措施。方法以283例住院>48 h接受机械通气(MV)患者为调查对象,对其临床资料、病原菌分布特点作回顾性分析。结果并发VAP有56例,发病率为19.79%,共检出病原菌189株,其中革兰阴性杆菌89株,占47.09%,革兰阳性球菌64株,占33.86%,下呼吸道分泌物共分离出104株,回路冷凝液共分离出85株,两组标本病原菌分布、构成比差异无统计学意义;发生与未发生VAP危险因素比较,差异有统计学意义(P<0.05)。结论 VAP的发生是多因素的综合,采取多种行之有效的干预措施,加强培训和监督,规范医疗和护理行为,注重医院感染控制,可预防和减少VAP的发病率,降低死亡率。
Objective To investigate the causes of ICU ventilator-associated pneumonia (VAP) and interventions. Methods A total of 283 hospitalized patients undergoing mechanical ventilation (MV) for 48 hours were enrolled in this study. The clinical data and distribution characteristics of pathogens were analyzed retrospectively. Results There were 56 concurrent VAP cases with the incidence rate of 19.79%. A total of 189 pathogenic bacteria were detected, of which 89 strains were Gram-negative bacilli (47.09%) and 64 strains were Gram-positive cocci (33.86%). Lower respiratory secretions were isolated 104 strains were isolated, and 85 strains were isolated from the loop condensate. There was no significant difference in the distribution of pathogens between the two groups. The risk factors of occurrence and non-occurrence of VAP were statistically significant (P <0.05). Conclusions The occurrence of VAP is a multifactorial combination. Various effective interventions are taken to strengthen training and supervision, standardize medical care and nursing behaviors, pay attention to nosocomial infection control, prevent and reduce the incidence of VAP and reduce mortality.