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危重患者最常见的感染性并发症是呼吸机相关性肺炎(ventilator-associated pneumonia,VAP),它是医院获得性感染患者死亡的首要原因。VAP显著增加发病率和死亡率,延长机械通气和住院时间,增加医疗服务的成本。尽管VAP的发病率高、影响深远,却不如急性心肌梗死或肺栓塞的诊断方法清晰、易于应用和验证其诊断标准,一直缺乏统一的诊断标准。疾病控制中心、美国胸科协会和美国传染病学会已提出建议,VAP的诊断和治疗重点在于改善预防措施、建立广泛应用和精确诊断的方法以及改善VAP治疗指南中的远期管理方法。本文综述VAP对重症监护病房患者的影响,以及这种致命并发症的预防、诊断和治疗的最新进展。
The most common infectious complication in critically ill patients is ventilator-associated pneumonia (VAP), which is the leading cause of death in hospital-acquired infections. VAP significantly increases morbidity and mortality, increases mechanical ventilation and hospital stays, and increases the cost of medical services. Despite the high incidence of VAP, far-reaching, but not as acute myocardial infarction or pulmonary embolism diagnostic method is clear, easy to apply and verify its diagnostic criteria, the lack of a unified diagnostic criteria. The Centers for Disease Control, the American Thoracic Society and the American Society of Infectious Diseases have suggested that the diagnosis and treatment of VAPs focus on improving preventive measures, establishing methods for widespread use and accurate diagnosis, and improving long-term management approaches in VAP treatment guidelines. This article reviews the impact of VAP on intensive care unit patients and the latest advances in the prevention, diagnosis and treatment of this fatal complication.