急性呼吸衰竭无创机械通气患者医院获得性肺炎的病原菌分布及相关因素

Distribution of pathogenic bacteria and related factors of hospital-acquired pneumonia in patients with acute respiratory failure after noninvasive mechanical ventilation

目的探讨急性呼吸衰竭无创通气患者医院获得性肺炎的病原菌分布情况,并分析其相关因素。方法回顾性收集2017年5月至2021年5月医院发生医院获得性肺炎的急性呼吸衰竭无创机械通气患者42例临床资料,纳入发生组;并收集同期医院未发生医院获得性肺炎的急性呼吸衰竭无创机械通气患者42例临床资料,纳入未发生组。收集发生组患者病原菌检查结果,分析其分布情况;设计基线资料调查,查阅患者临床资料,重点分析急性呼吸衰竭无创机械通气患者医院获得性肺炎发生的相关因素。结果42例发生医院获得性肺炎的急性呼吸衰竭无创机械通气患者痰标本中共分离出病原菌68株,其中以革兰阴性菌为主,占比61.76%,其中鲍曼不动杆菌较为常见(22.06%),肺炎克雷伯菌(14.71%)次之;革兰阳性菌占比26.47%,以金黄色葡萄球菌为主,占比14.71%;发生组合并糖尿病高于未发生组,急性生理与慢性健康系统(APACHE-Ⅱ)评分、血清降钙素原(PCT)高于未发生组,血清白蛋白水平低于未发生组,差异有统计学意义(P<0.05);组间其他基线资料及实验室指标比较,差异无统计学意义(P>0.05);经多元Logistic回归分析,结果显示,合并糖尿病、APACHE-Ⅱ评分、血清白蛋白、血清PCT对急性呼吸衰竭无创机械通气患者医院感染性肺炎的影响存在统计学关联,其中合并糖尿病及APACHE-Ⅱ评分、血清PCT高为危险因素(OR>1,P<0.05),血清白蛋白水平高为保护因素(OR<1,P<0.05)。结论急性呼吸衰竭无创机械通气患者医院获得性肺炎以革兰阴性菌感染为主,且其发生的相关因素可能为合并糖尿病、APACHE-Ⅱ评分、血清白蛋白、血清PCT。

Objective To investigate the distribution of pathogenic bacteria of hospital-acquired pneumonia in patients with acute respiratory failure after noninvasive ventilation,and to analyze its related factors.Methods The clinical data of 42 patients with acute respiratory failure after noninvasive mechanical ventilation in the hospital from May 2017 to May 2021 were retrospectively collected and included in the occurrence group;and the clinical data of 42 patients with acute respiratory failure who did not have hospital-acquired pneumonia during the same period in the hospital were collected and included in the non occurrence group.The results of pathogenic bacteria examination of patients in the occurrence group were collected,its distribution was analyzed;designed the baseline data survey,the clinical data of patients were consulted,the related factors of hospital-acquired pneumonia in patients with acute respiratory failure aftter noninvasive mechanical ventilation were mainly analyzed.Results 68 strains of pathogenic bacteria were isolated from sputum samples of 42 patients with acute respiratory failure after noninvasive mechanical ventilation who had hospital-acquired pneumonia,most of them were gram negative bacteria,accounting for 61.76%,of which acinetobacter baumannii was more common(22.06%),followed by Klebsiella pneumoniae(14.71%);gram positive bacteria accounted for 26.47%,mainly was staphylococcus aureus,accounting for 14.71%;the combined diabetes mellitus in the occurrence group was higher than that of the non occurrence group,the acute physiology and chronic health system(APACHE-II)score and serum procalcitonin(PCT)were higher than those of the non occurrence group,and the serum albumin level was lower than that of the non occurrence group,the differences were statistically significant(P<0.05).There was no statistical significant difference in other baseline data and laboratory indexes between the two groups(P>0.05);by multiple Logistic regression analysis,the results showed that the influence of nosocomial pneumonia in patients with acute respiratory failure after noninvasive mechanical ventilation was statistically correlated with diabetes mellitus,APACHE-II score,serum albumin and serum PCT.Among them,diabetes mellitus and APACHE-II score and high serum PCT level were risk factors(OR>1,P<0.05),high serum albumin level was a protective factor(OR<1,P<0.05).Conclusion Gram negative bacteria infection is the main cause of hospital-acquired pneumonia in patients with acute respiratory failure after non-invasive mechanical ventilation,and its related factors may be diabetes mellitus,APACHE-II score,serum albumin and serum PCT.