本文選題：呼吸機相關(guān)性肺炎　切入點：細菌污染　出處：《中華醫(yī)院感染學(xué)雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的探討呼吸機管路內(nèi)細菌與下呼吸道感染時間的相關(guān)性,為預(yù)防呼吸機相關(guān)性肺炎(VAP)提供依據(jù)。方法選取2015年6月-2016年6月入住綜合ICU行機械通氣的Ⅱ型呼吸衰竭患者122例,于上機后在不同時間段采集下呼吸道分泌物、呼吸機濕化罐、進氣口及出氣口冷凝水集水杯、螺紋管呼氣接口內(nèi)壁標本進行細菌培養(yǎng),觀察不同部位細菌生長情況,記錄機械通氣時間、ICU住院時間、呼吸機相關(guān)性肺炎發(fā)生率等。結(jié)果 122例機械通氣患者,共收集培養(yǎng)標本1 898份,呼吸機濕化罐、進氣口及出氣口冷凝水集水杯、螺紋管呼氣接口內(nèi)壁細菌生長率與機械通氣時間呈正相關(guān)(r=0.8545,0.9636,0.9636,0.9394;P0.05);出氣口冷凝水集水杯細菌出現(xiàn)最早,呼吸機濕化罐細菌出現(xiàn)最晚;各部位與下呼吸道分泌物細菌培養(yǎng)均以革蘭陰性菌為主;全部患者中發(fā)生VAP19例,VAP發(fā)生率15.57%,隨著機械通氣時間的延長,VAP發(fā)生率逐漸增加,機械通氣時間5d與7d分組比較,VAP發(fā)生率差異有統(tǒng)計學(xué)意義(P0.05);19例VAP患者中,出氣口冷凝水集水杯、螺紋管呼氣端接口端內(nèi)壁、進氣口冷凝水集水杯及呼吸機濕化罐與下呼吸道分泌物細菌培養(yǎng)一致性分別為66.48%、63.45%、40.26%及54.32%,進氣口冷凝水集水杯及呼吸機濕化罐的細菌出現(xiàn)時間與下呼吸道病原菌的出現(xiàn)時間基本一致。結(jié)論呼吸機管路細菌污染狀況及VAP的發(fā)生與機械通氣時間均存在相關(guān)性,呼吸機管路細菌污染可能是造成VAP發(fā)生的原因之一,建議定期更換呼吸機管路。
[Abstract]:Objective to investigate the correlation between bacteria in ventilator and time of lower respiratory tract infection, for the prevention of ventilator-associated pneumonia (VAP) provides the basis for the 122 patients with type II respiratory failure. Methods from June 2015 June -2016 year in comprehensive ICU of mechanical ventilation in the upper respiratory tract were collected at different times after lower secretion, airway humidification, air inlet and the air outlet of the condensed water collecting cup, threaded pipe inner wall interface expiratory specimens for bacterial culture, bacterial growth was observed in different parts of the record, the mechanical ventilation time, ICU stay, the incidence of ventilator-associated pneumonia. Results 122 cases of patients with mechanical ventilation were collected, 1898 specimens were cultured, airway humidification, air inlet and outlet in the condensed water collecting cup, threaded pipe inner wall interface expiratory bacterial growth was positively correlated with the duration of mechanical ventilation (r= 0.8545,0.9636,0.9636,0.9394; P0.05); a Air condensate water bacteria appeared, airway humidification bacteria appears late; parts and secretion of lower respiratory tract bacterial culture were Gram-negative bacteria; VAP19 cases occurred in all patients, the incidence rate of VAP was 15.57%, with prolonged mechanical ventilation, the incidence of VAP increased gradually, compared with mechanical ventilation 5D and 7d group, there was significant difference in incidence of VAP (P0.05); 19 patients with VAP, the outlet of condensed water in the cup, threaded pipe end expiratory end wall interface, the condensed water inlet water and airway humidification and lower respiratory tract secretions bacterial culture consistency were 66.48%, 63.45%. 40.26% and 54.32%, and the condensed water inlet water airway humidification bacteria time and lower respiratory tract pathogens appeared almost at the same time. Conclusion the ventilator of bacterial contamination and the occurrence of VAP and mechanical ventilation There is a correlation between all of them. Bacterial contamination in ventilator pipeline may be one of the reasons for the occurrence of VAP. It is suggested that the ventilator pipeline should be replaced regularly.

【作者單位】： 河北醫(yī)科大學(xué)附屬華北石油管理局總醫(yī)院醫(yī)院感染管理科;
【分類號】：R563.1

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