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目的探讨小儿呼吸机相关肺炎(VAP)危险因素及防治策略。方法选取我院PICU及NICU机械通气患儿为研究对象,回顾性分析VAP发生的相关因素、VAP病原菌及药敏结果。结果278例入选研究病例发生VAP 108例,VAP发生率38.8%,其中新生儿VAP发生率44.9%。患儿年龄、血白蛋白浓度、抗生素使用时间、抗酸剂使用、静脉丙种球蛋白、激素、鼻饲、体位、重复气管插管以及机械通气参数吸气峰压(PIP)、呼气末正压(PEEP)等因素均与VAP发生有关。病原学以G-菌为主,前5位分别是铜绿假单胞菌、肺炎克雷白杆菌、鲍曼不动杆菌、大肠埃希菌、金黄色葡萄球菌。结论VAP发生与多种因素有关,其防治要采取综合措施。采取合理的通气策略减轻呼吸机相关性肺损伤(VILI),是降低VAP发病率的重要的一个方面。
Objective To investigate the risk factors of ventilator-associated pneumonia (VAP) in children and its prevention and treatment. Methods The children with PICU and NICU in our hospital were selected as the study objects, and the related factors of VAP, pathogens of VAP and drug susceptibility were retrospectively analyzed. Results A total of 278 VAP cases were enrolled in the study, 108 cases were VAP. The incidence of VAP was 38.8%. The incidence of VAP in neonates was 44.9%. Children age, serum albumin concentration, duration of antibiotic use, antacid use, intravenous gamma globulin, hormones, nasal feeding, body position, repeated endotracheal intubation, and mechanical ventilation parameters PIP, (PEEP) and other factors are related to the occurrence of VAP. Etiology to G-bacteria-based, the top 5 were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Staphylococcus aureus. Conclusion The occurrence of VAP is related to many factors, and its prevention and treatment should take comprehensive measures. A reasonable ventilation strategy to reduce ventilator-associated lung injury (VILI) is an important aspect of reducing the incidence of VAP.