呼吸机相关性气管支气管炎危险因素分析

Analysis of risk factors related to ventilator-associated tracheobronchitis

回顾性分析2010年1月-2013年12月机械通气时间超过48 h的178例患者的临床资料,其中呼吸机相关性气管支气管炎（VAT） 56例.对患者年龄、性别、高血压、糖尿病、BMI、机械通气时间、气管插管方式、头部是否抬高30 ～45°、是否使用质子泵抑制剂、是否预防性使用抗生素、格拉斯哥昏迷评分（GCS）和急性生理学与慢性健康状况评分（APACHEⅡ）等相关因素进行单因素logistic回归分析及多因素logistic回归分析.单因素logistic分析发现性别、血压、BMI、气管插管方式及是否使用质子泵抑制剂对VAT的影响无统计学意义（P＞0.05）,而年龄、血糖、机械通气时间、是否头部抬高、是否预防性使用抗生素、GCS评分和APACHEⅡ评分7个指标与VAT相关性有统计学意义（P＜0.05）,多因素logistic回归分析发现,影响VAT危险因素为机械通气时间（OR =4.072,95％CI：2.036 ～8.146）、GCS评分[2.198（1.155 ～4.184）]、年龄[2.128（1.119 ～4.046）]、APACHEⅡ评分[2.109（1.084～4.104）]、头部是否抬高30 ～45°[0.488（0.243～0.979）].

A total of 178 patients with the time of mechanical ventilation beyond 48 hours in the second affiliated hospital of Wenzhou medical college from January 2010 to December 2013 were enrolled in this study,and there were fifty-six patients with ventilator-associated tracheobronchitis （VAT）.The associated factors included age,sex,blood pressure,blood glucose,BMI,the time of mechanical ventilation,tracheal intubation methods,raise head to 30-45°,proton pump inhibitors （PPI）,prophylactic antibiotic treatment,glasgow coma scale （GCS）,acute physiology and chronic health evaluation （APECHE） Ⅱ score.The related factors of VAT were evaluated by using univariate logistical regression analysis,and the statistical significant variables were analyzed by using multivariate logistical regression analysis.By using univariate logistical regression analysis age,blood glucose,the time of mechanical ventilation,raise head to 30-45°,prophylactic antibiotic treatment,GCS and APECHE Ⅱ score were the important factors of VAT （P 〈 0.05）,but sex,blood pressure,BMI,tracheal intubation methods and PPI were insignificant related to VAT（P 〉 0.05）.By using multivariate logistical regression analysis the time of mechanical ventilation （OR =4.072,95% CI 2.036-8.146）,GCS[2.198（1.155-4.184）],age[2.128 （1.119-4.046）],APECHE Ⅱ score [2.109 （1.084-4.104）] and raise head to 30-45 ° [0.488 （0.243-0.979）] were associated independently with the VAT.The time of mechanical ventilation,GCS,age over 60 years,APECHE Ⅱ score and raise head to 30-45°were the independent factors associated with VAT.