新生儿呼吸机相关性肺炎危险因素及预防对策

Risk factors and preventive measures of ventilator- associated pneumonia in neonates

目的探讨引起新生儿呼吸机相关性肺炎相关因素以及临床预防对策,以降低其发生率。方法回顾性分析2005年9月-2012年5月170例呼吸机治疗的新生儿临床资料,将呼吸机相关性肺炎作为观察组,无呼吸机相关性肺炎患儿作为对照组,对可能引起呼吸机相关性肺炎相关因素进行单因素检验及logistic回归分析。结果新生儿发生呼吸机相关性肺炎发生率23.53%,单因素分析结果发现,早产儿、低体重、APACHEⅡ评分低、白蛋白水平低、应用鼻胃管、应用抗酸剂、预防应用抗菌药物、胃内容物反流、呼吸机应用时间9个因素,两组分布差异有统计学意义(P<0.05),非条件logistic回归模型结果显示,新生儿呼吸机相关性肺炎危险因素为:早产儿(OR=3.57)、呼吸机应用时间长(OR=3.09)、白蛋白水平低(OR=2.95)、预防应用抗菌药物(OR=2.67)。结论新生儿呼吸机相关性肺炎发生率较高,与多种因素相关,应对上述相关危险因素采取相应措施,减少新生儿呼吸机相关性肺炎的发生。

OBJECTIVE To explore the relevant factors causing ventilator-associated pneumonia in neonates and clinical preventive measures, so as to reduce the incidence of the ventilator-associated pneumonia. METHODS A retrospective analysis was conducted on the clinical data of 170 cases of neonates treated with ventilator from Sep. 2005 to May 2012. The neonates with ventilator-associated pneumonia were the observation group, and the neonates with no ventilator-associated pneumonia were the control group. Single factor test and logistic regression analysis were performed on the relevant factors which would probably cause the ventilator-associated pneumonia. RESULTS The incidence of ventilator-associated pneumonia in neonates was 23. 53%. As the results of single factor analysis, nine factors of premature, low weight, low APACHE Ⅱ score, low albumin level, the application of nasogastric tube, application of antacid, preventive use of antimicrobial drugs, reverse flow of stomach contents, using time of ventilator were found. The differences between the two groups were statistically significant （P〈0.05）. The results of unconditional logistic regression model showed that the risk factors of ventilator-asso-ciated pneumonia in neonates included： premature （OR=3.57）, long time of ventilator using （OR=3.09）, low albumin levels （OR = 2.95）, preventive use of antimicrobial drugs （OR = 2.67）. CONCLUSION The incidence of ventilator-associated pneumonia in neonates is high and is related to many factors. The corresponding measures for the above factors should be taken to reduce the occurrence of ventilator-associated pneumonia in neonates.