医院获得性肺炎的预防.ppt

02避免鼻窦炎减少胃肠道潴留减少胃肠道细菌定植减少误吸减少误吸引发的肺炎04人力资源配备预防性抗生素其他措施01避免气管插管(NPPV)缩短机械通气时间避免或缩短机械通气03减少呼吸道操作物理治疗与气道管理减少吸入引发的肺炎医院获得性肺炎的预防措施增加总护理时间其他措施—人力资源配置NeedlemanJ,etal.Nurse-staffinglevelsandthequalityofcareinhospitals.NEnglJMed2002;346:1715-22增加总护理时间内科患者住院日 -3.5(1.5–5.7) .01泌尿系感染 -9.0(6.1–11.9) .001上消化道出血 -5.1(0.5–9.7) .03医院获得性肺炎 -6.4(2.8–10.0) .001休克或心跳骤停 -9.4(2.6–16.3) .007抢救失败 -2.5(0.0–5.0) .05外科患者泌尿系感染 -4.9(0.3–9.5) .04每天没有ICU医生查房其他措施—人力资源配置PronovostPJ,JenckesMW,DormanT,etal:Organizationalcharacteristicsofintensivecareunitsrelatedtooutcomesofabdominalaorticsurgery.JAMA1999;281:1310–1317A住院病死率 OR3.0(95%CI1.9–4.9)B心跳骤停 OR2.9(95%CI1.2–7.0)C急性肾功能衰竭 OR2.2(95%CI1.3–3.9)D菌血症 OR1.8(95%CI1.2–2.6)E输注血小板 OR6.4(95%CI3.2–12.4)F再次插管 OR2.0(95%CI1.0–4.1)其他措施—人力资源配置PronovostPJ,AngusDC,DormanT,RobinsonKA,DremsizovTT,YoungTL.Physicianstaffingpatternsandclinicaloutcomesincriticallyillpatients:asystemicreview.JAMA2002;288:2151-216210.90.80.70.60.50.41.61.51.41.31.21.1Favorshigh-intensityFavorslow-intensityRelativeRiskHospitalMortalityICUMortality0.71(0.62–0.82)0.61(0.50–0.75)其他措施—人力资源配置PronovostPJ,AngusDC,DormanT,RobinsonKA,DremsizovTT,YoungTL.Physicianstaffingpatternsandclinicaloutcomesincriticallyillpatients:asystemicreview.JAMA2002;288:2151-2162Favorshigh-intensityICUstaffingFavorshigh-intensityICUstaffingFavorslow-intensityICUstaffingFavorslow-intensityICUstaffing预防性抗生素:昏迷患者的早发性肺炎头颅创伤或卒中引发的昏迷GCS?12及机械通气72h(n=100)插管后静脉头孢呋肟1.5gx2(n=50)对照组(n=50)预防性抗生素(n=17)未用抗生素(n=33)12(24%)4(23%)21(64%)P=0.016P=0.007早发性肺炎70%(26/37)预防性抗生素:迟发性肺炎无抗生素(n=92)抗生素(n=59)P值诊断时间(天)4?310?80.05革兰阴性杆菌18(20%)28(48%)0.05耐药细菌1(1%)10(17%)0.05第二次肺炎28(30%)25(43%)