机械通气老年患者院内气管支气管炎危险因素分析

Investigation of the risk factors and prevention of nosocomial tracheobronchitis in elderly patients on mechanical ventilation in surgical intensive care unit

目的探讨机械通气老年患者并发院内气管支气管炎(NTB)的危险因素,为制定院内感染防治措施提供流行病学资料和科学依据。方法应用前瞻性队列研究方法,观察2002年10月—2004年7月收治上海复旦大学附属中山医院外科重症监护室(SICU)内的老年机械通气患者的临床资料,进行单因素和多因素Logistic回归分析。结果符合标准的66例SICU内机械通气老年患者有35例发生NTB(发生率为53.03%)。NTB组和非NTB组在低白蛋白血症、鼻饲情况、机械通气时间、急性生理学与慢性健康状况评分(APACHE)、抗生素使用种数以及住SICU时间方面差异均有显著性(P<0.05或P<0.01)。单因素分析显示:鼻饲、低白蛋白血症、机械通气时间>4d、住SICU时间>9d、抗生素使用种数增加以及APACHE评分>9分是NTB发生的重要危险因素;Logistic多因素回归分析显示:鼻饲、机械通气时间>4d、抗生素使用种数>2种是NTB的独立发病危险因素。结论SICU内机械通气老年患者NTB的发生率较高,是影响患者预后的重要因素之一。机械通气时间延长、ICU内住院时间延长、低白蛋白血症、高APACHE评分、大量使用抗生素等是NTB发生的重要危险因素。

Objective To investigate the incidence, the risk factors and the outcome of nosocomial tracheobronchitis （NTB） in patients age over 65 years of age receiving mechanical ventilation （MV）. Methods Using prospective cohort study to collect and analyse the clinical information of elderly patients who received mechanical ventilation in surgical intensive care unit （ICU）of Zhongshan Hospital, from November 2002 to July 2004. Patients with first episodes of NTB were compared with those without NTB by univariate analysis and logistic regression. Results There were 35 elderly patients diagnosed as having NTB （53.0%）. The differences in serum albumin, nasal feeding, the length of ICU stay, the duration of MV days, the acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score and the kinds of the antibiotic used between patients with NTB and without NTB were significant. The results of the univariate analysis showed that nasal feeding, low serum albumin, the duration of the MV〉4 days, the length of ICU stay 〉9 days, the kinds of antibiotics used and the APACHE Ⅱ score higher than 9 were the risk factors of NTB. However the logistic reggression suggested that nasal feeding, MV days 〉4 days, nasal feeding and the kinds of the antibiotics used 〉2 are the independent risk factors of NTB. Conclusion There is high incidence of NTB in ventilated patients in surgical ICU. Low albumin level, nasal feeding, prolonged MV and ICU stay days, high APACH Ⅱ score and administration of too much antibiotics are the important risk factors of NTB.