東部某醫學中心外科加護病房呼吸器相關肺炎感染危險因子的探討

Ventilator Associated Pneumonia and Its Risk Factors in a Surgical Intensive CareUnit--A Study at a Teaching Hospital in Eastern Taiwan

本研究之目的為針對使用呼吸器病患相關肺炎的危險因子進行探討，依據找出的相關危險因子，提供制定相關技術標準之參考，以預防並有效降低院內呼吸器相關肺炎的感染率。研究採回溯方法，配合本院醫療志業發展處之TQIP(Taiwan Quality Indicator Project)指標計畫進行，對象為本院外科加護病房2002年7月至12月共156名住院病患，其中有102人使用呼吸器，是呼吸器相關肺炎(Ventilator-associated pneumonia)的高危險群，使用呼吸器的病人中有23名出現院內肺炎感染。研究結果發現病人的年齡、住院天數、使用呼吸器天數、長期臥床、濕化治療、鼻胃管及H2拮抗劑之使用等，是呼吸器相關肺炎的危險因子(p<.05)。在相關危險因子中，建議可以改善的方向為：訂定使用呼吸器病患藥物濕化治療之相關護理標準技術，以避免因人員操作的差異性及認知不足，導致疏忽無菌技術而造成感染，並加強人員的品管標準及認知。另藥物濕化治療之形式中，小量噴霧治療及定量吸入的臨床使用已漸趨增加，待相關護理標準技術制訂後，兩者之間的比較，是未來研究的方向之一。The purpose of this study was to determine the factors which placed ventilated patients at a risk of developing pneumonias, and upon determining the risk factors, decreased patients' exposure to such factors; then finally, formulated a standardized ventilating method. This was a retrospective study, based on the hospital's Taiwan quality indicator project (TQIP). Data was gathered from a total of 156 patients admitted to the surgical intensive care unit (SICU) from July 2002 to December 2002. There were 102 patients placed on ventilators, and 23 developed nosocomial pneumonia. This study found that patients' age, length of hospital stay, length of time on the ventilator, being bedridden, usage of inhalation therapy, presence of nasogastric tube as well as H2 blocker administration were all risk factors for developing ventilatorassociated pneumonia (p < 0.05). By improving the knowledge of the nursing staff as well as ventilator operation, therapeutic inhalation procedure and aseptic technique, the number of nosocomial infections can be decreased. Comparison of the nursing staff's knowledge and usage of various inhalational methods, such as small volume nebulizer and metered dose inhaler, is a topic for future research.