小儿呼吸机相关性肺炎的危险因素分析

Analysis of the risk factors of ventilator associated pneumonia in children

目的探讨小儿呼吸机相关性肺炎(VAP)的相关危险因素,为临床诊断、治疗及预后评估提供依据。方法选择2008年1月至2012年6月该院收治的248例行机械通气患儿的临床资料,将发生VAP的68例患儿作为VAP组,未发生VAP的180例患儿作为非VAP组,分别对两组患儿相关危险因素进行单因素分析,将有显著相关性的危险因素纳入logistic回归模型做进一步分析。结果单因素分析显示,营养状态、营养支持方式、降钙素原水平、痰量分度、合并原发性肺部疾病、昏迷、机械通气时间、激素使用8个危险因素与VAP发生存在明显相关性;logistic回归分析提示,降钙素原水平、机械通气时间、痰量分度、激素使用4个危险因素与VAP发生存在明显相关性。结论对于降钙素原水平明显升高、机械通气时间长、痰多痰稠、排痰不畅、使用激素的患儿,应尽早给予相应处理,以降低小儿VAP发生率及病死率,改善预后。

Objective To explore the risk factors of ventilator associated pneumonia （VAP） in children related to me-chanical ventilation,providing the valuable data for clinical diagnosis,treatment and prognosis. Methods The clinical data from 248 children patients undergoing mechanical ventilationfrom January 2008 to June 2012 in this hospital were divided into VAP-group（68 cases） and non-VAP group（180 cases）,whose risk factors in the two groups were conducted single factor analysis. And the significant risk factors were considered into logistic regressive model analysis. Results The single factor analysis showed that nutrition condition,nutrition supporting method,procalciton in level,sputum scale,complicated primary lung diseases,coma,me-chanical ventilation time,glucocorticoids application were significantly associated,and it also demonstrated that the four risk fac-tors such asprocalcitonin level,sputumscale,mechanical ventilation time,glucocorticoids application were closely correlated to ventilator associated pneumonia. Conclusion For those with procalciton in level increased distinctively ,long mechanical ventila-tion time,much sputumand hardly elimination of sputum,glucocorticoids application,it should be given correspondent treatment to reduce the morbidity and mortality of ventilator associated pneumonia in child renpatients and improve prognosis conditions.