重症监护室呼吸机相关性肺炎独立危险因素分析及护理对策

Independent Risk Factor Analysis and Nursing Intervention of Ventilator-associated Pneumonia in Intensive Care Units

目的:探讨重症监护室患者呼吸机相关性肺炎(VAP)的独立危险因素,寻找相应的护理干预措施。方法:回顾性分析重症监护室120例机械通气患者的临床资料,根据发生VAP与否分组,先行单因素分析筛选出有统计学意义的变量,再行Logistic回归逐步分析确定VAP的独立危险因素,制定相应的护理措施。结果:发生VAP与未发生VAP的患者单因素分析显示在插管方式、抑酸剂、机械通气时间、入住重症监护室时间、镇静评分、昏迷评分、使用激素和应用呼吸机前48h使用抗菌药物等比较,差异有统计学意义(P<0.05)。多因素分析只有抑酸剂、机械通气时间、昏迷评分及应用呼吸机前48h使用抗菌药物是重症监护室VAP发生的独立危险因素(OR值分别为4.674、2.681、7.542和3.690)。结论:通过对重症监护室VAP独立危险因素的分析,有利于制定科学的护理干预措施,为降低VAP的发生率奠定基础。

Objective： To investigate the independent risk factors of ventilator-associated pneumonia （ VAP） in patients of intensive care units （ ICU ） , and to search for corresponding nursing interventions. Method： The clinical data of 120 patients with mechanical ventilation of ICU were retrospectively analyzed. The patients were assiqned according to whether they suffered from VAP or not. Statistically significant variables were screened by single factor analysis, and then Logistic regression analysis was conducted to confirm the independent risk factors of VAP. Corresponding nursing interventions were consequently formulated.Result ： The single factor analysis of patients with VAP and without VAP revealed that the differences in intubation way, acid inhibitor, time of mechanical ventilation, length of stay in ICU, sedation and coma scores, use of hormones, and use of antibacterials at 48h before use of a ventilator were statistically significant （ P〈 0.05）. And multiplicity revealed that only acid inhibitor, time of mechanical ventilation, coma score, and use of antibacterials at 48h before use of a ventilator were independent risk factors of VAP in ICU （ the OR values were 4.674, 2.681, 7.542, and 3.690, respectively）.Conclusion： Analysis on independent risk factors of VAP in ICU is beneficial to formulating scientific nursing interventions, and establishes the foundation for decreasing the incidence of VAP.