ICU呼吸机相关性肺炎危险因素的Logistic回归性分析以及病原菌研究

Logistic regression analysis and pathogen research of ICU ventilator-associated pneumonia's risk factors

目的研究ICU呼吸机相关性肺炎(VAP)危险因素的Logistic回归性分析以及病原菌研究。方法选取2012年8月-2013年8月该院ICU中进行机械通气时长>48h的患者。检查后将其分成VAP组53例及非VAP组51例,对两组各临床指标进行单因素分析以及Logistic回归性分析,并研究VAP组患者病原菌的构成情况。结果 VAP组机械通气时间、住院时间及ICU时间均长于非VAP组,留置胃管、使用抑酸剂、糖皮质激素、亚胺培南、第2代头孢菌素,肺感染型肺部疾病及肺外感染比例均显著高于非VAP组,差异均有统计学意义(P<0.05)。将VAP作为因变量,根据多因素的Logistic回归性分析可知,留置胃管、使用抑酸剂、糖皮质激素、亚胺培南及肺外感染均是VAP的危险因素。53例VAP患者的标本共培养各类病原菌98株,其中革兰阴性菌72株,占73.47%,革兰阳性菌26株,占26.53%,革兰阴性菌比例显著大于革兰阳性菌,差异有统计学意义(P<0.05)。结论 ICU中VAP发病因素较多,临床医务人员应重点关注其病原菌情况,结合VAP危险因素进行针对性的预防和治疗,值得临床推广。

Objective To study the logistic regression analysis and pathogen research of ICU ventilator -associated pneumonia′s risk factors.Methods 104 patients of mechanical ventilation time 〉48h were selected in the ICU of our hospital from August 2012 to August 2013.After checked and confirmed,104 patients were divided into VAP group（53 cases）and non-VAP group（51 cases）.Two groups′clinical indicators was done each single factor analysis and Logistic regression analysis . Researched the VAP group′s composition of the pathogen .Results The time of mechanical ventilation , hospitalization time and ICU times of VAP group were longer than non-VAP group;The proportion of indwelling stomach tube ,using antacids ,glu-cocorticoids,imipenem,the second generation cephalosporins ,lung infection type of lung disease and extrapulmonary infection were significantly higher than non-VAP group,the differences were statistically significant （P〈0.05）.Logistic regression anal-ysis based on the discovery,indwelling stomach tube,using antacids,corticosteroids,imipenem and pulmonary infections were risk factors for VAP.53 cases of VAP patients with various types of nosophyte had sputum culture of 98 pathogens,including gram-negative bacteria of 72,accounting for 73.47%,significantly greater than the Gram-positive bacteria of 26,accounting for 26.53%,the difference was statistically significant （P〈0.05）.Conclusion The incidence of VAP in ICU have many fac-tors,clinicians should focus their pathogens ,the combination of risk factors for VAP is treated by targeted prevention and treat-ment.It is worthy of attention .