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目的探讨目标监测对降低医院综合ICU呼吸机相关性肺炎(VAP)的作用,为VAP的预防提供科学依据。方法对2010年1月-2012年12月收住综合ICU使用机械性通气48h后或撤机拔管48h内的患者进行目标性监测,并采取一系列医院感染控制干预措施,以患者平均病情严重程度调整法(ASIS)调整医院感染发病率。结果 2 231例患者中发生医院感染313例次,例次感染率14.03%,例次千日感染率为24.04‰,患者ASIS评分3.82分,根据ASIS法调整后患者例次千日感染率为5.11‰;呼吸机置管总天数为6 071d,发生VAP 113例次,2010年VAP的例次千日感染率为27.27‰,采取干预措施后2012年下降至13.70‰;2010-2013年患者ASIS评分值差异无统计学意义。结论通过对综合ICU目标性监测和实施医院感染控制干预措施,可以有效预防和控制VAP的发生。
Objective To explore the effect of target monitoring on reducing ventilator associated pneumonia (VAP) in hospital ICU and to provide a scientific basis for the prevention of VAP. Methods From January 2010 to December 2012, ICU patients were admitted to ICU with mechanical ventilation 48h or weaning extubation within 48h after the targeted monitoring, and to take a series of nosocomial infection control interventions, the average patient’s condition was serious The degree of adjustment method (ASIS) to adjust the incidence of nosocomial infections. Results A total of 313 cases of nosocomial infections occurred in 231 cases, the incidence rate of infection was 14.03%, the incidence of infection was 24.04 ‰, and the ASIS score was 3.82. According to the ASIS method, the adjusted incidence of infection was 5.11 ‰; the total number of days of ventilator catheterization 6 071d, the occurrence of VAP 113 cases, the annual incidence of VAP in 2010 thousands of days was 27.27 ‰, after taking interventions dropped to 13. 70 ‰ in 2012; 2010-2013 patients with ASIS score No significant difference in value. Conclusions Objective-based surveillance and implementation of nosocomial infection control interventions in ICU can effectively prevent and control the occurrence of VAP.