呼吸机相关性肺炎呼吸机相关性肺炎北京三博脑科医院北京三博脑科医院ICUICUVAPVAP的定义的定义呼吸机相关性肺炎（呼吸机相关性肺炎（ventilation-associatedventilation-associatedpenumoniapenumonia，，VAPVAP））气管插管或气管切开气管插管或气管切开机械通气机械通气4848小时后小时后撤机拔管撤机拔管4848小时内小时内新的肺实质感染新的肺实质感染HAPHAP最常见（最常见（80%80%）和最严重的类型）和最严重的类型是呼吸机应用过程中最常见的并发症是呼吸机应用过程中最常见的并发症VAPVAP的流行病学的流行病学根据患者人群不同，患病率介于根据患者人群不同，患病率介于6-52%6-52%不不等等整个整个MVMV过程中，肺炎危险性平均每天增过程中，肺炎危险性平均每天增加加1%1%不同医院中不同医院中VAPVAP的病死率为的病死率为24-76%24-76%接受接受MVMV的的ICUICU患者，一旦出现肺炎，病患者，一旦出现肺炎，病死率可增加死率可增加2-102-10倍倍美国美国ICUICU中插管相关感染分布中插管相关感染分布（（2002.1-2004.62002.1-2004.6，，NNISNNIS））VAPrate（infections/1000days）PercentileTypeofICUNo.ofunitsVentilator-daysPooledmean10%25%50%(median)75%90%Coronary5976,1454.401.946.89.8Cardiothoracic4798,3587.21.22.96.312.615.5Medical92268,5184.90.52.13.76.28.9Medical-surgicalMajorteaching99320,9165.41.22.64.67.29.9Allothers109351,7055.11.72.95.16.78.9Neurosurgical2945,07311.202.46.213.516.8Pediatric52133,9952.900.92.34.88.1Surgical98253,9009.32.24.78.312.217.9Trauma2263,13715.24.3811.416.625.3Burn1423,11712-----Respiratory618,8384.9-----AmJInfectControl2004;32:470-85.VAPrate（infections/1000days）PercentileTypeofICUNo.ofinfectionsVentilator-daysInfectionRate%10%25%50%75%90%Coronary78379620.550.00.03.16.411.2Cardiothoracic2301294517.770.02.45.111.815.5Medical65225228.860.01.93.66.79.6Medical-surgicalMajorteaching6752727924.740.02.84.97.812.1AllothersNeurosurgical196815024.051.75.39.617.419.4Pediatric32206115.530.00.02.24.39.0Surgical5082004925.342.25.18.313.818.4Trauma80198440.32-----Respiratory97510219.01-----上海市上海市VAPVAP与与NNISNNIS比较（比较（20052005））VAPVAP病原体病原体细菌占细菌占90%90%以上以上混合感染占混合感...
