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目的分析重症监护病房(ICU)肿瘤患者呼吸机相关性肺炎(VAP)的发生原因,探讨最佳预防措施,从而有效减少VAP的发生率。方法对2013年1月-2014年12月入住ICU使用呼吸机时间>48 h的肿瘤患者采取目标性监测。其中2013年采用常规护理措施,不进行干预;2014年按照制定的VAP预防控制措施进行干预,并对患者发生VAP的原因进行评价分析。结果采用干预措施后,ICU肿瘤患者VAP千日感染率从干预前8.71‰下降至干预后的2.30‰;呼吸机使用率从干预前的63%上升至干预后的72%。各年度检出的病原菌中多药耐药菌构成比亦呈下降趋势。结论 ICU使用呼吸机的肿瘤患者易发生VAP,落实干预措施、加强呼吸机的管理、保持患者呼吸道通畅,可防止新的医院感染的发生。
Objective To analyze the causes of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients and explore the best preventive measures to reduce the incidence of VAP. Methods Tumor patients admitted to the ICU with ventilator time> 48 h were enrolled in this study from January 2013 to December 2014. Among them, the routine nursing interventions were adopted in 2013 with no intervention; in 2014, interventions were made in accordance with the established VAP prevention and control measures, and the causes of VAP in the patients were evaluated and analyzed. Results After intervention, the infection rate of VAP in ICU tumor patients decreased from 8.71 ‰ before intervention to 2.30 ‰ after intervention; and the ventilator utilization rate increased from 63% before intervention to 72% after intervention. The detection rates of multidrug-resistant bacteria in pathogens also showed a decreasing trend in each year. Conclusion ICU patients with cancer of the ventilator prone to VAP, the implementation of interventions to strengthen the management of ventilator to keep the patient’s airway open to prevent the occurrence of a new hospital infection.