重症监护病房呼吸机相关性肺炎危险因素分析

Analysis of Risk factors for Ventilator-associated Pneumonia in Intensive Care Unit

目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)发病特点和相关危险因素。方法回顾性调查我院ICU住院并实施机械通气超过48 h的患者的临床资料和微生物学资料,按照VAP诊断标准分VAP组和非VAP组。统计分析确定与VAP发病关系密切的危险因素。结果单因素分析结果显示,非感染慢性肺部疾病等14项因素有统计学意义。多因素logistic回归分析显示,与VAP发病关系密切的危险因素有5项:非感染慢性肺部疾病、机械通气时间、留置胃管肠饲营养、应用H2-受体拮抗剂或制酸剂和抗菌素联合应用(>2种)。结论ICU病房VAP是外部的医院环境和患者自身的内环境多种因素综合作用的结果,根据VAP的相关危险因素进行综合管理,重点监控,采取不同预防策略联合应用,才能有效的预防和减少VAP的发生。

Objective To discuss the clinical character and risk factors（RF） of ventilator-associated pneumonia （VAP） in Intensive Care Unit （ICU）. Methods The clinical data and micro-organism data of 138 patients with mechanical ventilation （MV） over 48 h admitted to ICU were analyzed retrospectively. The patients were divided into group VAP and Non-VAP according to the diagnostic criteria. Several significant RFs were screened out and determined with statistical analysis. Results Single factor analysis showed that 14 factors, such as non-infection lung disease（ N-ILD ）, hypoproteinemia, conscious disturbance, et al. were related to the occurrence of VAP. Multi-variable logistic analysis identified N-ILD, duration of MV, indwelling NT, H2-RB or AI and combined use of over 2 types of antibiotics as the 5 independent RFs of VAP. Conclusions VAP is not only the most common nosocomial infection from patients with MV, but also one of the most frequently kind of acquired pneumonia in hospital. Various factors from the hospital environment and the patient condition contributed to VAP in ICU. Application of comprehensive management, critical surveillance and combined use of various preventive strategies according to VAP associated factors can prevent and reduce VAP effectively.