结核重症监护室呼吸机相关性肺炎感染的危险因素分析

Analysis of risk factors of ventilator-associated pneumonia in an intensive care unit

目的：通过对结核ICU中的呼吸机相关性肺炎（VAP）患者的临床资料分析，对其VAP的高危因素及其特点进行探讨。方法回顾性收集2014年1月~2015年6月本院重症监护病房（ICU）143名患者的临床资料，根据VAP的诊断标准把患者是否发生VAP分为两组，用多因素Logistic回归分析筛选结核ICU内出现VAP感染的危险因素。对两组患者的通气时间及住院时间进行对比分析。结果比较肺结核与非结核患者两组间VAP发生率和死亡率差异有统计学意义；根据有无VAP感染分组，单因素分析结果显示患者在机械通气的时间、侵入性检查、肺结核、肺部结构改变、使用多种抗生素、糖尿病、气管切开、留置胃管、APACHEⅡ评分及昏迷与VAP的发生存在相关性，比较两组间存在显著性差异（P〈0.05），而多因素Logistic回归分析显示：肺结核、机械通气时间、APACHEⅡ评分、侵入性操作、使用多种抗生素是VAP发生的独立危险因素（P〈0.05）。VAP患者的机械通气时间和住院时间延长。结论结核ICU内VAP的发生率和死亡率较高，其发生是多种因素的共同作用结果。肺结核、机械通气时间、APACHEⅡ评分〉15分、侵入性操作、使用多种抗生素是结核ICU内患者感染VAP的独立危险因素。

Objective To explore the risk factors of ventilator-associated pneumonia （VAP） in patients admitted in an intensive care unit （ICU） for pulmonary tuberculosis （TB）. Methods The clinical data of 143 patients admitted in the ICU at our center between January, 2014 and June, 2015 were reviewed. The patients with VAP and those without VAP were analyzed for risk factors of VAP in the setting of an ICU for pulmonary TB and compared for the duration of ventilation and hospital stay. Results The patients with pulmonary TB showed a significantly higher incidence of VAP in the ICU than those without TB. Univariate analysis suggested that the occurrence of VAP was significantly correlated with the duration of mechanical ventilation, invasive examination, pulmonary tuberculosis, lung structure changes, use of multiple antibiotics, diabetes, tracheal incision, indwelling gastric tube, APACHE II score, and coma （P〈0.05）. Multivariate logistic regression analysis showed that pulmonary TB, duration of mechanical ventilation, APACHE II score, invasive operation, and use of multiple antibiotics were independent risk factors for VAP （P〈0.05）. The patients who developed VAP had a prolonged duration of mechanical ventilation and ICU stay （P〈0.05）. Conclusion Patients admitted in tuberculosis ICU are exposed to a high risk of VAP with a high mortality rate as the result of multiple interacting risk factors. Pulmonary TB, prolonged mechanical ventilation, an APACHE II score 〉15, invasive operation, and use of multiple antibiotics are all independent risk factors for VAP in tuberculosis ICU.