先天性心脏病术后呼吸机相关性肺炎影响因素分析

Analysis of the risk factors of ventilator-associated pneumonia following pediatric cardiac operation

目的探讨先天性心脏病(先心病)术后引起呼吸机相关性肺炎(VAP)的因素和相应的护理措施。方法对2007年1—12月在上海某专科儿童医院监护室内应用机械通气超过48 h,且发生VAP的先心病术后患儿59例的临床资料进行总结,运用Logistic分析,研究影响先心病术后VAP发生的危险因素。结果长时间体外循环、延迟关胸、再插管、选用的营养支持方式和床头抬高措施与先心病术后患儿发生VAP有相关性。结论对存在VAP危险因素的患儿制定适当的护理干预措施可有效减少先心病术后患儿VAP的发生。

Objective Study on the risk factors of VAP after pediatric cardiac operation and nursing measures for it＇s prevention. Methods Between January 2007 and December 2007, 283 congenital heart disease patients used mechanical ventilation more than 48 hours after cardiac operation. Fifty nine of them got VAP. Using logistic regression analysis, factors as gender, prolonged eardiopulmonary bypass, delayed sternal closure, reintubation, the ways of artificial, chest physical therapeusis, head-up position, nutrition, ways of feeding, mouth care and complications were analyzed between the two groups with and without VAP group. Results Y = 0.823X2 ＋ 1. 417X3 ＋ 1. 182X4 - 0.984X9 - 0.814X11 - 2. 607. Prolonged cardiopulmonary bypass, delayed sternal closure and reintubation could increase the incidence of VAP. Using enteral nutrition and head-up position could decreased incidence by VAP. There were no influence by other factors. Conclusion Some correlation factors were found after the research and some nursing measures could be taken to prevent or decrease the occurrence of VAP.