下列哪些病人發生院內感染性肺炎（HAP）的風險最高？（選所有適合的）
Which of the following clients are at the highest risk for developing hospital-acquired pneumonia? (Select all that apply.)
- AA client receiving mechanical ventilation through an endotracheal tube一位經氣管內管接受機械通氣的病人正確答案
- BA client with an indwelling urinary catheter一位留置導尿管的病人
- CA client receiving continuous enteral tube feedings一位接受持續性管灌餵食的病人正確答案
- DA client who smokes one pack of cigarettes daily at home一位在家每天抽一包菸的病人
- EA client on prolonged bed rest following hip surgery一位髖部手術後長期臥床的病人正確答案
- A一位經氣管內管接受機械通氣的病人
- C一位接受持續性管灌餵食的病人
- E一位髖部手術後長期臥床的病人
院內感染肺炎的高風險族群為 A、C、E。選項 A：使用氣管內管接受機械通氣者，人工氣道繞過鼻咽的過濾、加溫與加濕功能，並削弱咳嗽反射與纖毛清除能力，含菌分泌物會沿氣管內管外壁滲入下呼吸道，是呼吸器相關肺炎的最高風險群。選項 C：接受連續性管灌者，胃內容物逆流與吸入的風險顯著升高，而吸入是院內肺炎的主要成因之一，照護上應維持床頭抬高 30 至 45 度並定期評估耐受性。選項 E：長期臥床者無法有效深呼吸與咳嗽，容易發生肺擴張不全（atelectasis），塌陷的肺泡成為細菌繁殖的溫床。選項 B 錯誤：留置導尿管主要增加的是導尿管相關泌尿道感染（CAUTI）的風險，與肺炎無直接關聯。選項 D 錯誤：吸菸雖是社區型肺炎與慢性肺病的長期危險因子，但並非住院期間發生院內肺炎的主要驅動因素，其風險遠低於人工氣道與管灌等侵入性介入。
- A · 正確答案一位經氣管內管接受機械通氣的病人
呼吸器相關肺炎是院內最常見的肺部感染，因人工氣道繞過上呼吸道防禦。
- B一位留置導尿管的病人
導尿管主要增加泌尿道感染風險，與肺部感染無直接統計學相關。
- C · 正確答案一位接受持續性管灌餵食的病人
管灌餵食易發生胃內容物逆流，特別是在仰臥病人身上，易導致吸入性肺炎。
- D一位在家每天抽一包菸的病人
吸菸雖損傷肺功能，但不是院內感染的急性危險因子。
- E · 正確答案一位髖部手術後長期臥床的病人
長期臥床造成肺部通氣不足與分泌物滯留，是肺炎發生的關鍵溫床。
美國 ICU 實施嚴格 VAP Bundle (Bundle care)；台灣多採感控指引，但在落實頻率與標準化程度上可能略有不同。
English explanation
Options A, C, and E are correct. Option A is a highest-risk situation because an endotracheal tube bypasses nasopharyngeal filtering, warming, and humidifying functions and weakens cough and ciliary clearance. Contaminated secretions can leak along the tube into the lower respiratory tract, creating a major risk for ventilator-associated pneumonia. Option C is correct because continuous enteral feeding substantially increases gastric reflux and aspiration risk, and aspiration is a major cause of hospital-acquired pneumonia. Care should include elevating the head of the bed 30-45 degrees and regularly assessing feeding tolerance. Option E is correct because prolonged bed rest impairs deep breathing and effective coughing, encouraging atelectasis; collapsed alveoli can support bacterial growth. Option B is not selected because an indwelling urinary catheter mainly raises the risk of catheter-associated urinary tract infection rather than pneumonia. Option D is not selected because smoking is a long-term risk factor for community-acquired pneumonia and chronic lung disease, but it is not a primary driver of pneumonia during hospitalization and presents far less risk than an artificial airway or tube feeding.