重症监护病房呼吸机相关性肺炎的危险因素分析

Risk factors of ventilator-associated pneumonia in ICU

目的探讨重症监护室(ICU)呼吸机相关性肺炎的危险因素。方法收集2011年3—9月入住新疆医科大学第一附属医院ICU行机械通气超过48 h患者的临床资料,按诊断标准分发生呼吸机相关性肺炎(VAP)组和未发生VAP组,对两组患者相关危险因素进行比较分析。结果 154例发生VAP患者中,共检出病原274株,革兰阴性菌占85.04%,居前3位的病原菌为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌。Logistic回归分析显示,感染的主要危险因素为机械通气时间≥5 d、昏迷、抗生素联合使用。结论防治VAP应根据其相关危险因素进行综合处理。

Objective To analyze the related risk factors of ventilator-associated pneumonia in ICU. Methods The clinical data of the patients who underwent mechanical ventilation for more than 48 hours in ICU from March 2011 to September 2011 were reviewed retrospectively. According to the diagnostic criteria, the patients were derided into 2 groups： patients with ventilator-associated pneumonia （VAP group） and VAP-free group. The risk factors were compared between these two groups. Results Of the 274 bacterial isolates, gram-negative bacteria accounted for 85.04%. The top three bacterial species were Acinetobacter baumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Logistic regression analysis indicated that the significant risk factors associated with VAP were the duration of mechanical ventilation, coma and antibiotic combination therapy. Conclusions Comprehensive management must be implemented according to the related risk factors of VAP.