下列哪位病人發生院內感染肺炎（HAP）的風險最高？
Which of the following clients is at the highest risk for developing hospital-acquired pneumonia (HAP)?
- AA client with a urinary tract infection receiving IV antibiotics正在接受靜脈抗生素治療的尿路感染病人
- BA client who is intubated and sedated on a mechanical ventilator✓ 正解插管並鎮靜於機械通氣機上的病人
- CA client who is ambulatory and recovering from hernia repair正在行走並從疝氣修復術中恢復的病人
- DA client who had an appendectomy yesterday昨天接受闌尾切除術的病人
呼吸器相關肺炎（VAP）是院內感染肺炎（HAP）中最嚴重的類型。氣管內插管（Endotracheal intubation）破壞了聲門的天然屏障，使得口咽部的細菌極易進入下呼吸道，加上機械通氣導致肺部擴張受限與分泌物堆積，使得插管病人成為 HAP 的最高風險族群。其他選項的病人多具備正常的呼吸道保護機制或活動能力，風險相對較低。
Ventilator-associated pneumonia (VAP) is the most serious type of hospital-acquired pneumonia (HAP). Endotracheal intubation disrupts the natural barrier of the glottis, allowing oropharyngeal bacteria to easily enter the lower respiratory tract. Combined with limited lung expansion and accumulation of secretions due to mechanical ventilation, intubated clients are the highest-risk group for HAP. Clients in the other options generally have intact airway defenses or are mobile, and their risk is comparatively low.
美國醫院對於 VAP 的預防有嚴格的 Bundle care（護理組合），包括抬高床頭（Head of bed elevation）、每日停用鎮靜劑評估（Sedation vacation）、口腔護理（Chlorhexidine mouthwash）等。護理師在這些預防措施的落實上扮演關鍵角色。