综合ICU内呼吸机相关性肺炎的多因素Logistic回归分析及护理对策

multivariate Logistic regression analysis of risk factors for ventilator-associated pneumonia in compreheusive ICU and nursing countermeasures

目的探讨综合ICU内呼吸机相关性肺炎（VAP）的发病率、危险因素以及护理对策。方法采用回顾性调查的方式。回顾2009年1～12月综合性ICU内机械通气时间〉48h的患者98例，使用调查表收集患者的临床资料，分为VAP组35例和非VAP组63例，对资料进行单因素分析与多元逐步Logistic回归分析，确定VAP的相关因素。结果VAP的发病率为35．7％。单因素分析结果显示APACHEII评分的高低、机械通气时间的长短、是否有原发肺部疾病、是否使用抑酸剂、是否半卧位、是否意外脱管、口腔护理方式、是否声门下吸引这8项与VAP的发生有关。多因素Logistic回归分析结果显示机械通气时间的长短、是否半卧位、是否声门下吸引这3项是VAP发生的相关因素。结论VAP是多种因素共同导致的结果；针对VAP的危险因素制定综合的护理对策，才能有效降低VAP的发病率。

Objective To explore the morbidity, risk factors and nursing of ventilator-associated pneumonia （VAP） in comprehensive ICU. Methods It was a retrospective survey. 98 mechanical ventilation （〉 48 h） patients from Jan to Dec, 2009 in comprehensive ICU were reviewed using questionnaires to collect the clinical data. They were divided into the VAP and the non- VAP group. Several statistically significant risk factors were screened out with univarite analysis, then independent risk factors were determined with multiple Logistic regression. Results The morbidity of VAP was 35.7%. Univariate analysis showed that the level of APACHE Ⅱ score, duration of mechanical ventilation, whether primary lung disease, whether acid-suppressing agents, whether the semi-supine, whether accidental tube removal, oral care approach, whether attracted to subglottic were statistically significant risk factors of VAP. While multivariate Logistic regression analysis showed that the duration of mechanical ventilation, whether the semi- supine, whether attracted to subglottie were the major risk factors of VAP. Conclusions The occurrence of VAP is related with multiple factors. Application of comprehensive prevention strategies in accordance with these risk factors of VAP can reduce the morbidity of VAP effectively.