CAJ | 학술논문

神经外科重症监护室（ NSICU）中，重度颅脑损伤及重大手术后，患者常伴意识障碍或处于意识模糊状态，常发生与之相关的呼吸闭塞或中枢性呼吸功能衰竭，需行气管插管或气管切开进行机械通气治疗，是NSICU中VAP发生的主要途径之一。病人发生一旦VAP，会产生严重的呼吸困难，进而加重病情并延长住院时间，甚至会造成死亡。现在，VAP的高发病率，高死亡率，高医疗资源消耗已经引起了高度重视，如何改进治疗及护理技术来降低VAP的发病率及病死率已提上日程。本文从VAP的发病危险因素和各项预防措施进行了具体阐述，总结了VAP的发生与发展与临床护理工作中的各项操作有着密不可分的关系。临床上各种护理措施如严格遵守无菌原则、气道护理、口腔护理、体位护理、翻身叩背、严格的呼吸机消毒及正确的操作、正确的给予肠内营养等简单易行且花费低，结合各种治疗措施等积极预防治疗VAP，是降低NSICU患者VAP发病率和病死率、缩短住院时间、降低医疗费用的关键。
신경외과중증감호실（ NSICU）중，중도로뇌손상급중대수술후，환자상반의식장애혹처우의식모호상태，상발생여지상관적호흡폐새혹중추성호흡공능쇠갈，수행기관삽관혹기관절개진행궤계통기치료，시NSICU중VAP발생적주요도경지일。병인발생일단VAP，회산생엄중적호흡곤난，진이가중병정병연장주원시간，심지회조성사망。현재，VAP적고발병솔，고사망솔，고의료자원소모이경인기료고도중시，여하개진치료급호리기술래강저VAP적발병솔급병사솔이제상일정。본문종VAP적발병위험인소화각항예방조시진행료구체천술，총결료VAP적발생여발전여림상호리공작중적각항조작유착밀불가분적관계。림상상각충호리조시여엄격준수무균원칙、기도호리、구강호리、체위호리、번신고배、엄격적호흡궤소독급정학적조작、정학적급여장내영양등간단역행차화비저，결합각충치료조시등적겁예방치료VAP，시강저NSICU환자VAP발병솔화병사솔、축단주원시간、강저의료비용적관건。
In the neurosurgical intensive care unit , patients with severe cerebral trauma and major surgery , often associated with dis-turbance of consciousness or unconsciousness , often associated with respiratory occlusion or central respiratory function failure , these patients need to endotracheal intubation or tracheotomy for mechanical ventilation treatment that was one of the main way to infect ventilator associated pneumonia ( VAP) in the NICU.Once patiens infect the ventilator associated pneumonia , there would be a severe breathing difficulties , thus aggravate illness and extend the length of hospital stay , and even cause death.Now, the high mortality , high consumption , high medi-cal resources and high incidence of VAP , had aroused great attention.How to improve the treatment and nursing techniques to reduce the in-cidence of VAP and fatality rate has been on the agenda.In this paper , the incidence of VAP risk factors and the preventive measures had carried on the detailed elaboration , the occurrence and development of the VAP were summarized and the relationship between the operations of clinical nursing work.All kinds of nursing measures such as strictly abide by the principle of aseptic , airway nursing, oral care, body po-sition nursing care , turn knocking back , strict disinfection of breathing machine and the right operation , the right to give enteral nutrition are simple and low cost , combined with various treatment measures actively to prevent VAP , was the key role to reduce the neurosurgical inten-sive care unit ventilator associated pneumonia of morbidity , mortality , the length of hospital stay and health care costs.