Hixson S, Sole M L, King T
Orlando Regional Healthcare System, FL, USA.
AACN Clin Issues. 1998 Feb;9(1):76-90; quiz 145-6. doi: 10.1097/00044067-199802000-00008.
Critically ill patients who require mechanical ventilation are at high risk for development of pneumonia during the course of treatment. Ventilator-associated pneumonia leads to higher rates of mortality and morbidity, increased length of hospital stay, and higher hospital costs. The intubation that is necessary for mechanical ventilation impairs the patient's normal defense mechanisms for fighting infection. Impaired defenses, along with such risk factors as age of the patient, equipment used, and failure of the staff to wash hands increase the likelihood of colonization of the lower airways. Colonization and subsequent pneumonia commonly occurs from microaspiration of secretions from the oropharynx and gastrointestinal tract. In this article, the mechanism of microaspiration, diagnosis of ventilator-associated pneumonia, and nursing strategies to reduce the incidence of pneumonia are described.
需要机械通气的重症患者在治疗过程中发生肺炎的风险很高。呼吸机相关性肺炎会导致更高的死亡率和发病率，延长住院时间，并增加住院费用。机械通气所需的插管会损害患者抵抗感染的正常防御机制。防御功能受损，再加上患者年龄、使用的设备以及工作人员未洗手等风险因素，增加了下呼吸道定植的可能性。定植及随后发生的肺炎通常源于口咽和胃肠道分泌物的微量误吸。本文描述了微量误吸的机制、呼吸机相关性肺炎的诊断以及降低肺炎发病率的护理策略。
