早产儿呼吸机相关性肺炎预防和管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2026.01.008

摘要/Abstract

摘要：

目的检索、评价并汇总国内外关于早产儿呼吸机相关性肺炎预防和管理的最佳证据，为临床护理实践提供参考依据。方法计算机检索国内外网站及数据库中关于早产儿呼吸机相关性肺炎预防和管理的文献，检索时限为2011年1月1日至2024年6月30日，对证据进行汇总、分级并归纳总结。结果最终纳入文献12篇，包括2篇指南、2篇专家共识、1篇随机对照试验、4篇Meta分析、3篇系统评价，提炼出5个主题共29条最佳证据。结论总结的最佳证据为临床护理人员预防和管理早产儿呼吸机相关性肺炎提供循证依据，有助于降低呼吸机相关性肺炎的发生率。

Abstract:

Objective To search，evaluate and summarize the best evidence on the prevention and management of ventilator-associated pneumonia（VAP） in premature infants，so as to provide reference for clinical nursing practice. Methods Computerized searches were conducted in domestic and international websites and databases for literature on the prevention and management of VAP in preterm infants from January 1，2011 to June 30，2024. The evidence was summarized，graded and synthesized. Results A total of 12 articles were included，including 2 guidelines，2 expert consensuses，1 randomized controlled trial，4 meta-analyses，and 3 systematic reviews. Five themes and 29 best evidence items were extracted. Conclusion The summarized best evidence provides evidence-based support for clinical nurses in preventing and managing VAP in preterm infants，which is helpful in reducing the incidence of ventilator-associated pneumonia.

Key words: Premature Infants, Ventilator-Associated Pneumonia, Prevention, Management, Summary of Evidence, Evidence-Based Nursing

张丹, 叶娟, 吴俐亚, 张梦瑜, 梁锦晶, 凌密. 早产儿呼吸机相关性肺炎预防和管理的最佳证据总结[J]. 中华急危重症护理杂志, 2026, 7(1): 54-60.

ZHANG Dan, YE Juan, WU Liya, ZHANG Mengyu, LIANG Jinjing, LING Mi. Summary of the best evidence for prevention and management of ventilator-associated pneumonia in preterm infants[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(1): 54-60.

图/表 5

参考文献 35

[1]	Cernada M, Aguar M, Brugada M, et al. Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique:a prospective observational study[J]. Pediatr Crit Care Med, 2013, 14(1):55-61. doi: 10.1097/PCC.0b013e318253ca31
[2]	许津莉, 郭华贤, 王佳慧, 等. 早产儿呼吸机相关性肺炎病原菌及危险因素[J]. 中华医院感染学杂志, 2021, 31(6):919-923.
	Xu JL, Guo HX, Wang JH, et al. Pathogens isolated from premature infants with ventilator-associated pneumonia and risk factors[J]. Chin J Nosocomiology, 2021, 31(6):919-923.
[3]	任军红, 殷环, 吴安华, 等. 新生儿重症监护病房器械相关感染流行病学多中心研究[J]. 中国感染控制杂志, 2015, 14(8):530-534.
	Ren JH, Yin H, Wu AH, et al. Multicenter study on epidemiology of device-associated infection in neonatal intensive care units[J]. Chin J Infect Contr, 2015, 14(8):530-534.
[4]	丁利, 宋伟, 朱雪萍. 新生儿呼吸机相关性肺炎病原学及不良预后高危因素分析[J]. 中国实用儿科杂志, 2020, 35(11):877-880.
	Ding L, Song W, Zhu XP. Analysis of pathogen and high risk factors for poor prognosis in newborns with ventilator-associated pneumonia[J]. Chin J Pract Pediatr, 2020, 35(11):877-880.
[5]	Thatrimontrichai A, Rujeerapaiboon N, Janjindamai W, et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates[J]. World J Pediatr, 2017, 13(4):328-334. doi: 10.1007/s12519-017-0010-0 pmid: 28120236
[6]	王文静, 周育萍, 黄秋娜, 等. 预防呼吸机相关性肺炎的指南证据总结[J]. 护理学报, 2021, 28(22):58-63. doi: 10.16460/j.issn1008-9969.2021.22.058
	Wang WJ, Zhou YP, Huang QN, et al. Summary of guidelines and evidence for preventing ventilator-associated pneumonia[J]. J Nurs China, 2021, 28(22):58-63.
[7]	刘玥, 张静萍. 新生儿重症监护室呼吸机相关性肺炎研究进展[J]. 中华医院感染学杂志, 2024, 34(4):628-634.
	Liu Y, Zhang JP. Research progress of ventilator-associated pneumonia in neonatal intensive care unit[J]. Chin J Nosocomiology, 2024, 34(4):628-634.
[8]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[9]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:Fine tuning 5S model into the 6S model[J]. Evid Based Nurs, 2009, 151(4):99-101.
[10]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. doi: 10.1016/j.ypmed.2010.08.005 pmid: 20728466
[11]	陈红丽, 张戈, 赵青, 等. 近10年国内护理专家共识文献质量评价与分析[J]. 中国护理管理, 2020, 20(3):399-406.
	Chen HL, Zhang G, Zhao Q, et al. Quality evaluation and analysis of domestic nursing experts’ consensus literature in the past ten years[J]. Chin Nurs Manag, 2020, 20(3):399-406.
[12]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research:The quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[13]	曾宪涛, 黄伟, 田国祥. Meta分析系列之九:Meta分析的质量评价工具[J]. 中国循证心血管医学杂志, 2013, 5(1):3-5.
	Zeng XT, Huang W, Tian GX. Meta-analysis series 9:quality evaluation tool of meta-analysis[J]. Chin J Evid Based Car-diovasc Med, 2013, 5(1):3-5.
[14]	The Joanna Briggs Institute(JBI)[EB/OL]. (2017-07)[2024-07]. http://joannabriggs-webdev.org/research/critical-appraisal-tools.html.
[15]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[16]	中国医师协会新生儿科医师分会循证专业委员会, 中国医师协会新生儿科医师分会呼吸专业委员会. 2020新生儿机械通气时气道内吸引操作指南[J]. 临床医学研究与实践, 2020, 5(20):2.
	Evidence-based Professional Committee of Neonatology Branch of Chinese Medical Doctor Association, Respiratory Professional Committee of Neonatology Branch of Chinese Medical Doctor Association. 2020 guidelines for the operation of airway suction during neonatal mechanical ventilation[J]. Clin Res Pract, 2020, 5(20):2.
[17]	中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J]. 中华内科杂志, 2013, 52(6):524-543.
	Critical Care Medicine Branch of the Chinese Medical Association. Guidelines for diagnosis,prevention and treatment of ventilator-associated pneumonia(2013) formulated by critical care medicine branch of Chinese medical association[J]. Chin J Intern Med, 2013, 52(6):524-543.
[18]	Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia,ventilator-associated events,and nonventilator hospital-acquired pneumonia in acute-care hospitals:2022 Update[J]. Infect Control Hosp Epidemiol, 2022, 43(6):687-713. doi: 10.1017/ice.2022.88
[19]	《中华儿科杂志》编辑委员会, 中华医学会儿科学分会呼吸学组, 中华医学会儿科学分会急救学组, 等. 儿童医院获得性肺炎管理方案(2010版)[J]. 中华儿科杂志, 2011, 49(2):106-115.
	The Editorial Board of Chinese Journal of Pediatrics, Respiratory Diseases Group of Pediatrics Branch of Chinese Medical Association, Emergency Group of Pediatrics Branch of Chinese Medical Association, et al. The management of hospital acquired pneumonia in children(2010)[J]. Chin J Pediatr, 2011, 49(2):106-115.
[20]	Zhu XW, Qi HB, Feng ZC, et al. Noninvasive high-frequency oscillatory ventilation vs nasal continuous positive airway pressure vs nasal intermittent positive pressure ventilation as postextubation support for preterm neonates in China:a randomized clinical trial[J]. JAMA Pediatr, 2022, 176(6):551-559. doi: 10.1001/jamapediatrics.2022.0710
[21]	崔昕, 谷晓玲, 田华雨, 等.碳酸氢钠口腔护理对新生儿呼吸机相关性肺炎发生率影响的Meta分析[J]. 循证护理, 2023, 9(22):4031-4035.
	Cui X, Gu XL, Tian HY, et al. Effect of sodium bicarbonate oral nursing on the incidence of ventilator-associated pneumonia in neonates:a Meta-analysis[J]. Chin Evid Based Nurs, 2023, 9(22):4031-4035.
[22]	杨迪, 高梦, 朱福英, 等. 新生儿重症监护室患儿并发呼吸机相关肺炎危险因素的Meta分析[J]. 南昌大学学报(医学版), 2022, 62(3):42-47.
	Yang D, Gao M, Zhu FY, et al. Risk factors for ventilator-associated pneumonia in children in neonatal intensive care unit:a Meta-analysis[J]. J Nanchang Univ Med Sci, 2022, 62(3):42-47.
[23]	蔡会文, 马月兰, 刘永戍, 等. 口腔免疫疗法对预防早产儿呼吸机相关性肺炎的Meta分析[J]. 中华现代护理杂志, 2021, 27(19):2563-2569.
	Cai HW, Ma YL, Liu YS, et al. Effects of oral immunotherapy for the prevention of ventilator-associated pneumonia in premature infants:a Meta-analysis[J]. Chin J Mod Nurs, 2021, 27(19):2563-2569.
[24]	刘冰冰, 曾子, 申靓亮, 等. 容量目标通气用于早产儿机械通气效果的Meta分析[J]. 护理研究, 2017, 31(23):2861-2867.
	Liu BB, Zeng Z, Shen LL, et al. Meta analysis of effect of volume target ventilation for mechanical ventilation in preterm infants[J]. Nurs Res China, 2017, 31(23):2861-2867.
[25]	Niedzwiecka T, Patton D, Walsh S, et al. What are the effects of care bundles on the incidence of ventilator-associated pneumonia in paediatric and neonatal intensive care units? A systematic review[J]. J Spec Pediatr Nurs, 2019, 24(4):e12264.
[26]	Ferguson KN, Roberts CT, Manley BJ, et al. Interventions to improve rates of successful extubation in preterm infants:a systematic review and meta-analysis[J]. JAMA Pediatr, 2017, 171(2):165-174. doi: 10.1001/jamapediatrics.2016.3015 pmid: 27918754
[27]	肖政, 汪成琼, 楚亚林, 等. 我国早产儿呼吸机相关性肺炎高危因素的荟萃分析[J]. 中华医院感染学杂志, 2014, 24(10):2536-2539.
	Xiao Z, Wang CQ, Chu YL, et al. Meta-analysis of high risk factors for ventilator-associated pneumonia in preterm newborns in China[J]. Chin J Nosocomiology, 2014, 24(10):2536-2539.
[28]	杨婷婷, 王军. 机械通气新生儿发生呼吸机相关性肺炎影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(2):234-239.
	Yang TT, Wang J. Influencing factors of ventilator-associated pneumonia in neonates with the treament of mechanical ventilation[J/OL]. Chin J Obstet Gynecol Pediatr Electron Ed, 2022, 18(2):234-239.
[29]	Keyt H, Faverio P, Restrepo MI. Prevention of ventilator-associated pneumonia in the intensive care unit:a review of the clinically relevant recent advancements[J]. Indian J Med Res, 2014, 139(6):814-821.
[30]	Disma N, Asai T, Cools E, et al. Airway management in neonates and infants:European society of anaesthesiology and intensive care and British journal of anaesthesia joint guidelines[J]. Eur J Anaesthesiol, 2024, 41(1):3-23. doi: 10.1097/EJA.0000000000001928
[31]	国家卫生和计划生育委员会. 重症监护病房医院感染预防与控制规范WS/T 509-2016[EB/OL].(2016-12-27)[2024-09-10]. http://www.nhc.gov.cn/wjw/s9496/201701/1f9de665633-04061a4fcd7f54a9399fb.shtml.
	National Health and Family Planning Commission. Specifica-tion for prevention and control of nosocomial infections in intensive care units WS/T 509-2016[EB/OL]. (2016-12-27)[2024-09-10]. http://www.nhc.gov.cn/wjw/s9496/201701/1f9de665633-04061a4fcd7f54a9399fb.shtml.
[32]	林楠, 诸纪华, 徐红贞, 等. 早产儿体位管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(4):486-492. doi: 10.3761/j.issn.0254-1769.2022.04.016
	Lin N, Zhu JH, Xu HZ, et al. Best evidence summary of positioning management for preterm infants[J]. Chin J Nurs, 2022, 57(4):486-492. doi: 10.3761/j.issn.0254-1769.2022.04.016
[33]	刘进, 李敏敏, 司在霞, 等. 气管插管新生儿口腔护理的最佳证据总结[J]. 当代护士(上旬刊), 2022, 29(5):14-17.
	Liu J, Li MM, Si ZX, et al. Summary of the best evidence of oral care for newborns with tracheal intubation[J]. Mod Nurse, 2022, 29(5):14-17.
[34]	Gokce IK, Kutman HGK, Uras N, et al. Successful implementation of a bundle strategy to prevent ventilator-associated pneumonia in a neonatal intensive care unit[J]. J Trop Pediatr, 2018, 64(3):183-188. doi: 10.1093/tropej/fmx044
[35]	Pinilla-González A, Solaz-García á, Parra-Llorca A, et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants[J]. J Perinatol, 2021, 41(6):1467-1473. doi: 10.1038/s41372-021-01086-7 pmid: 34035449