呼吸机相关呼吸机相关(xiāngguān)(xiāngguān)性肺炎性肺炎北京北京(běijīn)ɡ(běijīn)ɡ三博脑科医院三博脑科医院ICUICU第一页，共五十九页。第一页，共五十九页。呼吸机相关(xiāngguān)性肺炎（ventilation-associatedpenumonia，VAP）气管插管或气管切开机械通气48小时后撤机拔管48小时内新的肺实质感染第二页，共五十九页。第二页，共五十九页。HAP最常见（80%）和最严重的类型是呼吸机应用(yìngyòng)过程中最常见的并发症第三页，共五十九页。第三页，共五十九页。VAP的流行病学根据(gēnjù)患者人群不同，患病率介于6-52%不等整个MV过程中，肺炎危险性平均每天增加1%不同医院中VAP的病死率为24-76%接受MV的ICU患者，一旦出现肺炎，病死率可增加2-10倍第四页，共五十九页。第四页，共五十九页。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.第五页，共五十九页。第五页，共五十九页。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-----第六页，共五十九页。第六页，共五十九页。VAP病原体细菌(xìjūn)占90%以上混合感染占40%GNB85%，GPC↑52%，尤MRSA早发性VAP：以肺炎链球菌、流感嗜血杆菌等常见晚发性VAP：以绿脓杆菌、不动杆菌等耐药菌多见第七页，共五十九页。第七页，共五十九页。VAP病原体病原体病原体早发早发NN＝＝39(%)39(%)晚发晚发NN...
