Bauer T T, Ferrer R, Angrill J, Schultze-Werninghaus G, Torres A
Abteilung für Pneumologie, Allergologie und Schlafmedizin, Medizinische Klinik und Poliklinik, Bergmannsheil Klinikum der Ruhr-Universität, Bochum, Germany.
Semin Respir Infect. 2000 Dec;15(4):272-9. doi: 10.1053/srin.2000.20938.
Ventilator-associated pneumonia (VAP) is a pulmonary infection that occurs after at least 48 hours of mechanical ventilation (MV). The incidence depends on several factors, although the most important are those related to the host and duration of MV. VAP can be differentiated into early-onset (<5 days) and late-onset types (> or =5 days). The overall incidence of VAP varies between 9% and 70% (average, 20% to 25%), and the majority of episodes occur within the first 5 days. Risk factors for VAP include prolonged MV, older age, supine body position, and type of comorbidity. Oropharyngeal colonization appears to be a risk factor for early-onset pneumonia, whereas prolonged MV and antibiotic pretreatment, especially with broad-spectrum drugs, increase the risk for late-onset VAP Microaspiration of colonized oropharyngeal secretions is a major cause of early-onset VAP, most frequently caused by community-type pathogens. After 5 days of MV, pathological colonization with gram-negative bacteria may occur, and late-onset VAP is more likely to be attributable to this group of microorganism. Incidence, risk factors, and microbiology depend strongly on the time frame in which the episode develops. However, initial and pathological colonization during the intensive care unit stay can modify this concept.
呼吸机相关性肺炎（VAP）是指在机械通气（MV）至少48小时后发生的肺部感染。其发病率取决于多种因素，其中最重要的是与宿主相关的因素以及机械通气的持续时间。VAP可分为早发性（<5天）和晚发性（≥5天）类型。VAP的总体发病率在9%至70%之间（平均为20%至25%），且大多数发作发生在最初5天内。VAP的危险因素包括机械通气时间延长、年龄较大、仰卧体位以及合并症类型。口咽部定植似乎是早发性肺炎的一个危险因素，而机械通气时间延长和抗生素预处理，尤其是使用广谱药物，会增加晚发性VAP的风险。定植的口咽部分泌物的微量误吸是早发性VAP的主要原因，最常见的病原体是社区获得性类型。机械通气5天后，可能会出现革兰氏阴性菌的病理性定植，晚发性VAP更可能归因于这组微生物。发病率、危险因素和微生物学在很大程度上取决于发病的时间范围。然而，在重症监护病房住院期间的初始定植和病理性定植可能会改变这一概念。
