新生儿重症监护室新生儿呼吸机相关性肺炎的临床分析

Clinical Analysis of Neonatal Ventilator Associated Pneumonia in Neonatal Intensive Care Unit

目的：探讨新生儿重症监护室（NICU）新生儿呼吸机相关性肺炎（NVAP）的危险因素、病原菌分布、耐药情况及患儿预后。方法选择2012年10月至2013年9月安徽医科大学附属六安医院 NICU收治并进行机械通气（MV）的80例患儿的临床病历资料为研究对象,按照患儿是否并发 NVAP,将其分为NVAP组（n=20）和非 NVAP组（n=60）。两组患儿的性别等一般临床资料比较,差异无统计学意义（P＞0.05）。回顾性分析 NICU患儿的 NVAP发生情况、危险因素、病原菌特点、耐药情况及预后,NVAP 的危险因素采用非条件多因素 logistic回归分析（本研究遵循的程序符合安徽医科大学附属六安医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书）。结果本组80例患儿 NVAP发生率为41.7‰。胎龄、MV治疗时间为 NVAP的独立危险因素[OR=0.366,95%CI（0.149~0.844）,P=0.026；OR=1.051,95%CI（1.008~1.090）,P=0.020],早期使用肺表面活性物质（PS）和血浆为 NVAP的保护因素[OR=0.048,95%CI（0.004~0.653）,P=0.023；OR=0.071,95%CI（0.008~0.628）,P=0.017]。病原菌分布以革兰阴性菌为主（18/26,69.2%）,其中前3位分别为鲍曼不动杆菌（30.8%,8/26）、肺炎克雷伯杆菌（15.4%,4/26）、大肠埃希菌（11.5%,3/26）, NVAP组患儿存在多重感染,均为合并真菌感染（23.1%,6/26）。NVAP 组患儿的住院时间、住院费用显著高于非 NVAP组,且差异均有统计学意义（t=2.832,P=0.006；t=3.656,P=0.000）,但两组患儿的病死率比较,差异无统计学意义（χ2=1.667,P=0.197）。结论 NICU收治患儿的 NVAP 发生率较高,其发生与多种因素密切相关,主要致病菌为革兰阴性菌且耐药率较高。需提高临床医师对 NVAP 的防治意识,加强抗菌药物的合理使用并采取综合干预措施防治 NVAP。

Objective To investigate the risk factors, pathogenic bacteria distribution, drug sensitivity and prognosis of neonatal ventilator associated pneumonia （NVAP）in neonatal intensive care unit （NICU）.Methods A retrospective analysis was performed on the clinical data of 80 cases who were admitted to NICU department and received mechanical ventilation （MV ） treatment in Lu′an Affiliated Hospital of Anhui Medical University from October 2012 to September 2013.According to whether complicated with NVAP or not,they were divided into NVAP group （n=20）and non-NVAP group （n=60）.There had no significant differences on general information between two groups （P〉0.05 ）.The independent risk factors, pathogenic bacteria distribution, drug sensitivity and prognosis were retrospectively analyzed.Unconditional multiple logistic regression was performed to detected risk factors of NVAP.The study protocol was approved by the Ethical Review Board of Investigation of Lu′an Affiliated Hospital of Anhui Medical University.Informed consent was obtained from all participates′patients. Results The incidence rate was 41.7‰.The independent risk factors for NVAP included gestational age and duration of MV treatment [OR=0.366,95%CI（0.149~0.844）,P=0.026;OR=1.051,95%CI （1.008~1.090）,P=0.020],and early use of pulmonary surfactant （PS）and plasma were the protective factors of NVAP [OR=0.048,95%CI（0.004~0.653）,P=0.023;OR=0.071,95%CI（0.008~0.628）, P=0.017].The most common isolated bacteria of the pathogen spectrum were Gram-negative bacteria, accounting for 69.2%（18/26）, among them, the top three bacteria were acinetobacter baumannii＆amp;nbsp;（30.8%,8/26）,Klebsiella pneumonia （15.4%,4/26）and Escherichiacoli （11.5%,3/26）.NVAP group existed multi-infection,and all combined with fungous infection（23.1%,6/26）.The statistically significant differences were found in hospital length of stay and hospitalization expense between NVAP group group and non-NVAP group （t=2.832,P=0.006;t=3.656,P=0.000）,but there had no statistical difference on the mortality between two groups （χ2=1.667,P=0.197）.Conclusions The NVAP incidence rate is high in the NIUC department of our hospital.NVAP is influenced by many factors,and the main pathogens for NVAP are Gram-negative bacteria, the multi-drug resistance is severe. It′s necessary to strengthen clinician′s awareness of NVAP,reasonable application of antibiotics,and take comprehensive measures to preventing NVAP.