呼吸机相关性肺炎危险因素的前瞻性研究

Pathogens and High Risk Factors of Ventilator-associated Pneumonia

目的研究呼吸机相关性肺炎(VAP)危险因素及各因素相互之间的作用,为有效防治VAP提供科学依据。方法前瞻性调查某三级医院2007年1-12月重症监护病房236例机械通气患者的相关危险因素;根据患者有无VAP将病例分为感染组和对照组,用2χ检验进行单因素分析,选择差异有统计学意义的因素进行Logistic回归分析。结果 VAP发病率为41.52%,病死率为37.76%;APACHEⅡ评分OR=1.175、年龄OR=1.069、机械通气时间OR=1.008、机械通气方式OR=0.203、湿化器微生物定植OR=0.024,是影响VAP发生的重要危险因素。结论加强危险因素监测,严格落实无菌操作制度,减少呼吸机管路的污染,尽可能缩短有创机械通气时间,可有效控制VAP的发生。

OBJECTIVE To study the risk factors of ventilator-associated pneumonia（VAP） in order to provide evidence for prevention and therapy of VAP.METHODS The related risk factors of VAP patients in a tertiary care hospital during Jan-Dec 2007 were prospectively investigated.The cases were divided into the infection group and the control group.Univariate chi-square was conducted and then non-condition Logistic regression analysis of the markedly different factors in the two groups was employed in SPSS15.0.RESULTS The morbidity of VAP was 41.52%.The mortality was 37.76%;the major risk factors might be the score of APACHEⅡ more than or equal to 15（OR=1.175）,the age over 60 years（OR=1.069）,the lasting time of mechanical ventilator more than or equal to 7 days（OR=1.008）,the way of mechanical ventilation（OR=0.203） and the microorganism colonization in the humidifler of ventilator（OR=0.024）.CONCLUSION It is suggested that precaution against VAP be reached through enhancing survey on the risk factors of VAP,attaching importance to bacteria-free operation technology,reducing bacterial pollution in the tube of ventilator,shortening the duration of invasive mechanical ventilation so as to contrl the incidence rate of VAP.