急诊呼吸机辅助通气相关性肺炎的危险因素分析和预防

Analysis on the Risk Factors of Emergency Ventilator-associated Pneumonia and Its Prevention

目的探讨急诊呼吸机辅助通气相关性肺炎(VAP)的危险因素及预防策略。方法选取2009年10月至2012年10月于福建医科大学附属龙岩第一医院呼吸内科治疗的重症患者50例,均采取呼吸机辅助通气治疗,再按其是否发生VAP分为VAP组20例和非VAP组30例,分析性别、年龄、机械通气时间、昏迷与否、ICU观察天数、抗生素联合使用情况、胃内容物吸入与否以及H2受体拮抗剂使用与否与VAP的相关性。结果机械通气时间>3 d、ICU观察天数>7 d、昏迷、联合应用抗生素种类>2种等因素均对VAP的发生造成影响(P<0.05);Logistic回归分析发现机械通气时间≥3 d(OR=2.387)、ICU观察天数>7 d(OR=2.142)、联合应用抗生素种类≤2种(OR=1.669)、胃内容物吸入(OR=1.779)、H2受体拮抗剂(OR=2.006)5个变量是VAP的危险因素。结论机械通气时间等因素是VAP的相关危险因素,临床上联合应用静脉注射抗生素及吸入抗生素可提高VAP患者的疗效。

Objective To investigate the risk factors of emergency ventilator-associated pneumonia （VAP） and its prevention. Methods A total of 50 cases of critically ill patients treated in Department of Respiratory Medicine of Longyan First Affiliated Hospital of Fujian Medical University from Oct. 2009 to Oct. 2012 were all given mechanical ventilation therapy, and divided into VAP group （n = 20 ） and non-VAP group （ n = 30 ）. Parameters of gender, age, duration of mechanical ventilation, coma, observation days in ICU, combined application of antibiotics ,inhalation of gastric contents, application of H2 receptor antagonist were analyzed to identify the risk factors of VAP. Results Duration of mechanical ventilation 〉 3 d, observation days in ICU 〉 7 d, coma, combined application of antibiotics 〉 2 kinds were risk factors of VAP（P 〈 0.05 ） ; results of logistic regression analysis showed that duration of mechanical ventilation ≥3 d （ OR = 2. 387 ）, observation days in ICU 〉 7 d（ OR = 2. 142 ） , combined application of antibiotics ≤ 2 kinds （OR = 1. 669 ） , inhalation of gastric contents （ OR = 1. 779 ）, H2 receptor antagonist （ OR = 2. 006） had close correlatian with VAP secondary pulmonary fungal infection. Conclusion Duration of mechanical ventilation and some other factors are the risk factors of ventilator-associated pneumonia, combined clinical application of intravenous antibiotics and inhaled antibiotics can improve the curative effect of VAP.