新生儿呼吸机相关性肺炎相关因素分析

Related Factors of Neonatal Ventilator-associated Pneumonia

目的分析新生儿呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发病的相关危险因素,指导临床防治工作。方法回顾性研究本院新生儿科2012年全年收治机械通气时间≥48h的216例患者及病原学资料,使用检验和Logistic回归进行统计分析。结果单因素分析发现早产、低出生体重、机械通气时间、上机次数差异有统计学意义(P<0.05),而多因素分析发现机械通气时间和上机次数与VAP发病相关。结论早产低体重儿免疫系统发育不成熟,易发生感染。气管插管将外界及口咽部细菌下移,气管导管停留时间越长,其表面细菌定殖越多,并以多重耐药菌为主。临床防治VAP提倡从患者管理、呼吸机管理、病房管理及人员管理各方面加强的集束化管理。

Objective Analyze the related factors of neonatal ventilator-associated pneumonia（VAP）,and provide help for clinical prevention and control. Methods A retrospective study was conducted on 216 patients with mechanical ventilation treatment over 48 hours who were admitted to NICU in our hospital at 2012. The data was collected from medical records and sub-mitted to statistical analysis by using test and logistic regression. Results Our data revealed that premature birth, low birth weight ,duration of mechanical ventilation and the number of mechanical ventilation were statistically significant in univariate analy-sis. However,duration of mechanical ventilation and the number of mechanical ventilation times were statistically significant in mul-tivariable analysis. Conclusion The results indicated that premature children had a higher risk of infection incidence because of the immature neonatal immune system. The endotracheal tube could facilitate bacterial from the outside and oropharyngeal entry in-to the lower respiratory tract and tracheal colonization. The surface bacterial colonization is increased with longer residence time of the endotracheal tube. Moreover,the bacteria are mainly multidrug-resistant. Therefore,our results suggested that clinical prevention should advocate cluster management,which were consisted of strengthen patient management,ventilator management,ward manage-ment,and personnel management.