呼吸机相关肺炎危险因素探讨

Study on risk factors for ventilator-associated pneumonia

目的探讨影响呼吸机相关肺炎（VAP）的危险因素。方法对2003年5月～2005年11月入住重症监护病房（ICU）采用机械通气治疗的360例患者进行回顾性队列研究，将患者按相关危险因素自然分组，采用x^2检验比较VAP发病率，并进行多因素非条件Logistie回归分析。结果360例行机械通气治疗的患者中有172例发生VAP，发病率为47．8％。机械通气≥5d、仰卧位、应用抑制胃酸分泌药、进行侵入性操作、应用糖皮质激素、白蛋白〈30g／L、多器官功能障碍综合征（MODS）与各自对照组比较，其机会比（OR）及伽值95％可信区间（95％CI）有统计学意义，是影响VAP发生的危险因素，其OR值分别为8．88、2．78、4．78、11．66、8．84、12．76和21．09（P均〈0．05）。结论机械通气较长时间、仰卧位、应用抑制胃酸分泌药（制酸剂）、侵入性操作、应用糖皮质激素、白蛋白〈30g／L、发生MODS是影响VAP发生的主要危险因素。

Objective To study the risk factors for ventilator-associated pneumonia （VAP）.Methods A retrospective cohort study was conducted in 360 patients who had received mechanical ventilation in intensive care unit from May 2003 to Nov 2005. Chi-square test and logistic regression were adopted to ananlyze the VAP incidence rate and related risk factors, respectively. Results The diagnosis of VAP was established in 172 cases with the incidence rate of 47.8% .The duration of mechanical ventilation ≥5 day, supine posture, gastric acid secretion inhibitor （GASI） therapy, invasive operation, corticosteroid use, albumen 〈 30g/L, and multiple organ dysfunction syndrome （MODS） were the risk factors for VAP, with odds ratios of 8.88, 2.78, 4.78, 11.66, 8.84, 12.76 and 21.09, respectively （all P 〈 0.05）. Conclusion The duration of mechanical ventilations〉5 day, supine posture, GASI therapy, invasive operation, corticosteroid use, albumen 〈 30g/L, and MODS are main risk factors for VAP.