摘要
目的调查儿科重症监护病房(PICU)呼吸机置管患儿发生呼吸机相关性肺炎(VAP)的病例,回顾性分析VAP发生的危险因素与特点,为预防和降低PICU呼吸机置管患儿VAP的发生率提供科学依据。方法分析2013年1月-2016年12月PICU前瞻性监测的呼吸机置管病例,对发生VAP的临床危险因素进行统计分析。结果 1545例呼吸机置管患儿发生VAP 69人,VAP发病率为10.02‰;1-3月呼吸机相关性肺炎发病率最低,7-9月呼吸机相关性肺炎发病率最高;置管时间越长,呼吸机相关性肺炎发病率越高,经外院转入的患儿VAP感染率高于其他途径入住PICU的患儿。结论置管时长与置管次数是PICU呼吸机置管患儿发生VAP的相关危险因素,严重的中枢疾病是VAP的易患因素。有效的口腔清洁及使用安全清洁的呼吸机管路可以降低VAP的发生率。医务人员应持续监测,严格执行清洁、消毒及无菌操作,掌握呼吸机置管指征,及时撤机,最大限度降低PICU呼吸机相关性肺炎的发生率。
OBJECTIVE To investigate the incidence of ventilator-associated pneumonia（VAP）in ventilator intubation children of pediatric intensive care unit（PICU）and retrospectively analyze the risk factors and characteristics of VAP so as to provide scientific basis for reduction of incidence of VAP.METHODS The children who were treated with ventilator intubation in PICU from Jan 2013 to Dec 2016 were analyzed,and the clinical risk factors for VAP were statistically analyzed.RESULTS Of the 1545 children who were treated with ventilator intubation,69 had VAP,with the morbidity rate 10.02‰ .The incidence rate of VAP was the lowest in January-March,and the incidence rate of VAP was the highest in July-September.The longer the catheter indwelling time,the higher the incidence rate of VAP was.The incidence rate of VAP was higher in the children who were transferred outside the hospital than in the children who were hospitalized the PICU through other approaches.CONCLUSION The long catheter indwelling time and number of times of intubation are the related risk factors for the VAP in the ventilator intubation children of the PICU,the severe central nervous system disease is the predisposing factor for the VAP.The effective oral cleaning and use of safe and clean ventilator pipelines can reduce the incidence of VAP.It is necessary for the health care workers to maintain sustained monitoring,strictly implement the cleaning,disinfection and aseptic operations,grasp the indications for ventilator intubation and withdraw the ventilator in a timely manner so as to minimize the incidence of VAP in the PICU.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第18期4210-4212,4251,共4页
Chinese Journal of Nosocomiology
基金
安徽省软科学研究专项基金资助项目(1607a0202055)
北京儿童医院集团科研基金资助项目(北儿集团学字2015-33-01)
关键词
儿童
呼吸机相关性肺炎
目标性监测
危险因素
Child
Ventilator-associated pneumonia
Targeted surveillance
Risk factor
