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目的分析比较实施3种消毒控制措施对重症监护病房(ICU)呼吸机相关性肺炎(VAP)预防效果,以控制VAP发生。方法选择2010年1月-2012年12月ICU所有机械通气≥5d患者797例,随机分为标准预防控制为对照组256例、应用75%乙醇强化消毒试验1组280例和三氯异氰尿酸强化消毒试验2组261例,3组均同时使用标准VAP预防策略,采用SPSS11.5软件进行统计分析,组间比较采用χ2检验,P<0.05为差异有统计学意义;采用WHONET5.4软件分析病原菌对抗菌药物的耐药率。结果 VAP发生率对照组为28.1%、试验1组为18.2%、试验2组为15.3%,试验1组及试验2组VAP发生率均显著低于对照组(P<0.05);检出铜绿假单胞菌及鲍氏不动杆菌对照组分别占23.6%及25.0%、试验1组分别占17.6%及41.2%、试验2组分别占42.5%及12.5%,试验1组与试验2组鲍氏不动杆菌、铜绿假单胞菌所占比例比较差异有统计学意义(P<0.05)。结论强化消毒控制措施可减少ICU VAP的发生率,预防VAP环境消毒时应根据致病菌流行病学特点选择适当的消毒剂。
Objective To analyze and compare the preventive effects of three kinds of disinfection control measures on ventilator associated pneumonia (VAP) in intensive care unit (ICU) so as to control the occurrence of VAP. Methods From January 2010 to December 2012, all 797 ICU patients with mechanical ventilation ≥5d were randomly divided into standard prevention and control for the control group of 256 cases, the application of 75% ethanol disinfection test in a group of 280 cases and trichloroisocyanuric acid 261 cases of intensive disinfection test in two groups, three groups were simultaneously using standard VAP prevention strategies, using SPSS11.5 software for statistical analysis, comparison between groups usingχ2 test, P <0.05 for the difference was statistically significant; using WHONET5.4 software analysis Pathogens resistant to antibiotics. Results The incidence of VAP was 28.1% in control group, 18.2% in test group 1 and 15.3% in test group 2, and the incidence of VAP in test group 1 and test group 2 was significantly lower than that of control group (P <0.05) Aeromonas and Acinetobacter baumannii control group accounted for 23.6% and 25.0%, respectively. The first group accounted for 17.6% and 41.2% respectively, the second and fourth groups accounted for 42.5% and 12.5% respectively. In the first and second groups, Acinetobacter, Pseudomonas aeruginosa proportion of the difference was statistically significant (P <0.05). Conclusion Intensified disinfection control measures can reduce the incidence of ICU VAP. To prevent the disinfection of VAP environment, appropriate disinfectants should be selected according to the epidemiological characteristics of pathogens.