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目的了解综合重症监护病房(ICU)机械通气患者医院感染发病率、临床特点、危险因素,探讨有针对性的预防措施。方法采用主动监测方法,由专职人员每日对综合ICU机械通气≥48 h及撤停机械通气拔除气道导管后48 h内患者进行医院感染监测。结果医院感染发病率为54.28%,医院感染例次发病率为65.71%,以呼吸机相关性肺炎(VAP)为主;VAP相关因素:实施≥4种侵入性操作比实施3种侵入性操作发生率高,气管切开比气管插管发生率高,差异有统计学意义(P<0.05),先气管插管后切开比先面罩后气管切开发生率高,差异有统计学意义(P<0.01);主要病原菌:革兰阴性杆菌排列前5位为鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、嗜麦芽寡养单胞菌;革兰阳性球菌主要为金黄色葡萄球菌。结论ICU机械通气患者医院感染发病率高,由多种高危因素引起,需采取综合措施,预防外源性感染,治疗与控制内源性感染。
Objective To understand the incidence, clinical characteristics and risk factors of nosocomial infections in patients with mechanical ventilation in intensive care unit (ICU) and to explore the targeted preventive measures. Methods The active monitoring method was adopted. The hospital staff were monitored daily by professional staff for ≥48 hours of mechanical ventilation of ICU and within 48 hours after removal of mechanical ventilation and removal of airway ducts. Results The incidence of nosocomial infection was 54.28%, and the incidence of nosocomial infections was 65.71%. The main cause was ventilator-associated pneumonia (VAP). VAP-related factors: more than 4 types of invasive operations were performed than 3 types of invasive procedures The incidence of tracheostomy was higher than that of tracheal intubation (P <0.05). The incidence of tracheotomy after tracheotomy was higher than that of tracheal intubation (P <0.05), and the difference was statistically significant (P <0.01). The main pathogens: the top 5 Gram-negative bacilli were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Stenotrophomonas maltophilia; Gram-positive Cocci mainly Staphylococcus aureus. Conclusion The incidence of nosocomial infections in ICU patients with mechanical ventilation is high and is caused by many risk factors. It is necessary to take comprehensive measures to prevent exogenous infection and to treat and control endogenous infections.