CAJ | 학술논문

目的：探讨神经内科 ICU 患者气管插管与气管切开后使用呼吸机，发生呼吸机相关性肺炎（VAP）的比较。方法对2013年1～12月使用有创呼吸机的166例患者进行统计，分析人工气道建立方式、VAP 发生率、VAP 发生时间、病原菌特征。结果经气管插管后切开 VAP 的发生率最高，高达55．00％；其次是单纯气管切开患者，VAP 的发生率为22．22％，单纯气管插管患者，VAP 的发生率为20．44％。VAP 发生时间是使用呼吸机＜5 d，占26．83％、使用呼吸机5～30 d，占58．54％、使用呼吸机＞30 d，占14．63％；VAP 感染的人数共27例，其中有10例为混合感染，共发生 VAP 感染41例，以革兰阴性菌为主，占85．36％，其次为革兰阳性菌（9．76％），真菌（4．88％）。结论神经内科 ICU 是 VAP 的高发科室，经气管切开 VAP 发生率大于经气管插管，并且气管插管/切开的次数和天数成为 VAP 发生的重要因素。
목적：탐토신경내과 ICU 환자기관삽관여기관절개후사용호흡궤，발생호흡궤상관성폐염（VAP）적비교。방법대2013년1～12월사용유창호흡궤적166례환자진행통계，분석인공기도건립방식、VAP 발생솔、VAP 발생시간、병원균특정。결과경기관삽관후절개 VAP 적발생솔최고，고체55．00％；기차시단순기관절개환자，VAP 적발생솔위22．22％，단순기관삽관환자，VAP 적발생솔위20．44％。VAP 발생시간시사용호흡궤＜5 d，점26．83％、사용호흡궤5～30 d，점58．54％、사용호흡궤＞30 d，점14．63％；VAP 감염적인수공27례，기중유10례위혼합감염，공발생 VAP 감염41례，이혁란음성균위주，점85．36％，기차위혁란양성균（9．76％），진균（4．88％）。결론신경내과 ICU 시 VAP 적고발과실，경기관절개 VAP 발생솔대우경기관삽관，병차기관삽관/절개적차수화천수성위 VAP 발생적중요인소。
Objective To compared explore the occurrence of ventilator-associated pneumonia after internal medicine intubation and tracheotomy in ICU neural Department.Methods The data of 166 invasive ventilator pa-tients were collected to analyze from January to December in 2013,analyze the artificial airway establishment wayL the incidence rate of VAP,VAP timeL pathogen characteristics.Results The incidence rat of VAP after internal medicine intubation combined with tracheotomy was the top as 55%L Tracheotomy as 22.22%L endotracheal intuba-tion as 20.44%;VAP took place after using ventilator <5 days,as the incidence rate was 26.83%,the ventilator 5-30 days as 58.54%Lthe ventilator more than 30 days as 14.63%;The number of VAP was a total of 27,including 10 cases of mixed infection.A total of 41 cases of VAP infection,including gram negative bacteria(85.36%),Gram posi-tive bacteria(9.76%),fungi(4.88%).Conclusion The ICU of Neurology has a high incidence of VAP,the incidence rate of VAP after tracheotomy is more than that after endotracheal intubation,tracheal intubation/ incision and the number of days is an important factor to the occurrence of VAP.