嬰幼兒先天性心臟病術(shù)后并發(fā)呼吸機相關(guān)性肺炎的誘因和對策分析

[摘要] 呼吸機相關(guān)性肺炎（VAP）是嬰幼兒先天性心臟病術(shù)后最為常見的并發(fā)癥之一，同時也是危及患兒生命重要的原因。對于呼吸機相關(guān)性肺炎發(fā)病原因的研究及對不同誘因相關(guān)護(hù)理對策的探索，一直是一線醫(yī)務(wù)工作者們關(guān)心的熱點和渴望解決的難題。本資料基于科室多年的嬰幼兒先天性心臟病術(shù)后護(hù)理的經(jīng)驗，就嬰幼兒這個特殊的群體，在考慮到其發(fā)育水平，免疫力和認(rèn)知水平等異于成年人的基礎(chǔ)上，著重分析了該年齡段先天性心臟病患者術(shù)后并發(fā)呼吸機相關(guān)性肺炎的原因，并針對各個誘因探討了相應(yīng)的護(hù)理對策。我們得出結(jié)論，嬰幼兒由于其特殊性，在先天性心臟病術(shù)后護(hù)理過程更應(yīng)該設(shè)法避免呼吸機相關(guān)性肺炎的發(fā)生，尤其是要在護(hù)理工作中注意操作規(guī)范和盡量杜絕醫(yī)源性感染。

[關(guān)鍵詞] 嬰幼兒；先天性心臟病；呼吸機相關(guān)性肺炎；術(shù)后護(hù)理

[中圖分類號] R726.5 [文獻(xiàn)標(biāo)識碼] A [文章編號] 2095-0616（2013）13-35-03

Analysis of induction factors and strategies for infants' ventilator-associated pneumonia causing by surgery of congenital heart disease

ZHANG Ruinan

Surgical Intensive Care Unit， Children's Hospital of Zhengzhou， Zhengzhou 450053， China

[Abstract] Ventilator-associated pneumonia （VAP） is a very common complication in infants who have surgeries because of congenital heart disease. VAP also leads high mortality rate. Medical workers have focused on VAP for a long time to find out countemesures which can prevent or cure VAP. In this review， the author summarized the details of factors which could cause VAP. Based on these， the author also discussed some strategies to avoid VAP. In consideration of infants， the author suggested that nursing staffs should lay stress on standard operation during their work， and try their best to avert VAP.

[Key words] Infant； Congenital heart disease； Ventilator-associated pneumonia； Postoperative care

我國新生兒先天性心臟病的發(fā)病率是0.67%，其中1/3在出生后6～12個月，另有1/3雖能渡過嬰幼兒期，但是會逐漸發(fā)展為中重度肺小動脈梗阻性病變，即使手術(shù)治療，其并發(fā)癥多且死亡率高[1]。因此對于嬰幼兒先天性心臟病的診斷，治療以及其并發(fā)癥的防治一直是該領(lǐng)域研究的前沿。

嬰幼兒先天性心臟病術(shù)后容易出現(xiàn)多種并發(fā)癥，如心律不齊、低心排出量綜合征、急性心包填塞以及出血等。隨著呼吸機應(yīng)用的日益廣泛，尤其是小兒呼吸機的面市與推廣，嬰幼兒先天性心臟病術(shù)后的存活率有了顯著地提高。……