呼吸机肺炎的影响因素与临床结局的关系

Ventilator-associated Pneumonia Related Factors and Clinical Outcome Relationship

目的:分析影响呼吸机相关肺炎(VAP)的相关因素,并探讨其与VAP患者临床结局的关系。方法:对我院2005年1月至2012年12月发生的100例VAP患者的临床资料作回顾性分析,采用SPSS13.0统计软件对相关因素与VAP患者的临床结局进行逐步logistic回归分析。结果:本组总病死率为15%,与VAP相关的病死率为10%。共分离病原菌120株,其中混合感染15例。使用抗生素者耐甲氧西林金黄色葡萄球菌(MRSA)、铜绿假单胞菌、醋酸钙不动杆菌、白色念珠菌所占比例分别为16.9%、13.6%、33.8%、13.6%,显著高于未使用者的1.6%、1.6%、1.6%、1.6%(P均<0.05)。醋酸钙不动杆菌占VAP相关的死亡患者分离出病原菌40%。单因素分析,年龄>45岁、致命性的基础疾病、先前使用抗生素及激素、住院>9 d、休克、COPD与VAP相关病死率相关(P均<0.05)。逐步logistic回归分析,仅先前使用抗生素是影响VAP相关病死率独立相关因素(P<0.05)。将VAP病原菌作为自变量,重复逐步logistic回归显示,先前使用抗生素因素被高危病原菌因素所替代(P<0.05)。高危病原菌包括MRSA、醋酸钙不动杆菌、铜绿假单胞菌、洋葱伯克霍尔德菌、白色念珠菌。结论:先前使用抗生素导致病原菌耐药与患者的病死率密切相关。

Objective： Analysis of ventilator-associated pneumonia（ VAP）,and its relationship with clinical outcomes in patients with VAP. Method： Retrospective analysis of clinical data for our hospital from January 2005 to December 2012,100 patients with VAP,using the statistical software SPSS13.0 stepwise logistic regression analysis of factors associated with the clinical outcome of patients with VAP. Result： The total mortality was 15%,the VAP- related mortality rate was 10%.？ 120 isolated pathogens,mixed with a sense of the 15 cases.？ Use of antibiotics-resistant Staphylococcus aureus（ MRSA）,Pseudomonas aeruginosa,Acinetobacter calcium acetate,Candida albicans proportion were 16.9%,13.6%,33.8%,13.6%,significantly higher than the？ not users of 1.6%,1.6%,1.6% and 1.6%（ P ＆lt;0.05）.？ Calcium acetate Acinetobacter VAP-related death in patients with isolated pathogens 40%.Univariate analysis,age＆gt; 45 years,fatal underlying disease,previous use of antibiotics and hormones,hospitalization＆gt; 9 d,shock,COPD-related mortality of VAP related（ P ＆lt;0.05）.Stepwise logistic regression analysis,the only previous use of antibiotics affect VAP-related mortality was independently associated factors（ P ＆lt;0.05）.？ Pathogens of VAP as an independent variable,repeated stepwise logistic regression analysis showed that previous use of antibiotics factors are replaced by high-risk pathogens factors（ P ＆lt;0.05）.？ The high-risk pathogens including MRSA,calcium acetate Acinetobacter,Pseudomonas aeruginosa,Burkholderia cepacia,Candida albicans. Conclusion： The mortality is closely related to the previous use of antibiotics lead to resistant pathogens patients.