老年患者呼吸机相关性肺炎高危因素meta分析

A meta analysis on risk factors of ventilator-associated pneumonia in elderly patients

目的评价>60岁老年患者呼吸机相关性肺炎(VAP)的发病因素,为临床治疗提供参考依据。方法系统检索万方、CNKI、维普、谷歌学术上已公开发表的中文文献;手动检索相关杂志、专业信息及网络资料,数据采用RevMan 5.3进行mata分析。结果共纳入6项研究,总样本量为951例;多因素分析显示,慢性呼吸病史、APACHE-Ⅱ评分、气管插管次数、气管插管时间、住院时间、吸痰次数等是老年患者VAP的独立危险因素(P<0.05),卧位(抬高床头30°)为保护性因素(P<0.05)。结论年龄、既往吸烟史、慢性呼吸病史、糖尿病史、APACHE-Ⅱ评分、低血清白蛋白、意识障碍、气管插管次数、气管插管时间、住院时间、留置胃管时间、吸痰次数、使用制酸剂为>60岁老年患者发生VAP的危险因素,卧位(抬高床头30°)为保护性因素。

OBJECTIVE To assess the risk factors of ventilator-associated pneumonia（VAP）in elderly patients over sixty years old,so as to provide reference for clinical treatment.METHODS The relevant Chinese studies published in Wanfang Data,CNKI Net,CQVIP Net and Scholar Google were given a system retrieval,other relevant magazine,professional information and internet material were searched manually.RevMan5.3was used to process meta analysis.RESULTS Six studies（951cases totally）concerning risk factors of VAP were included in the final analysis.The result of single factor analysis showed that history of chronic respiratory disease,APACHE II score,frequency of endotracheal intubation,duration of endotracheal intubation,hospitalization time,frequency of sputum suction had significant associations with VAP（P〈0.05）.The clinostatasm（raise the head of a bed up 30°）was the protective factor（P〈0.05）.CONCLUSIONAge,history of smoking,history of chronic respiratory disease,diabetes,APACHE Ⅱ score,low serum albumin,disturbance of consciousness,frequency of endotracheal intubation,duration of endotracheal intubation,hospitalization time,indwelling gastric tube time,frequency of sputum suction,and antacids use are risk factors for VAP in elderly patients over 60.Clinostatasm（raise the head of a bed up 30°）is the protective factor.