呼吸机相关性肺炎危险因素分析

Risk factors for ventilator-associated pneumonia

目的研究呼吸机相关性肺炎(VAP)的危险因素,制定有效的医院感染预防与控制措施。方法采用回顾性调查,选择2015年1-12月入住医院ICU中使用呼吸机超过48h、临床检查资料完整的703例患者作为调查对象,通过查阅病历的方式确定其是否发生VAP,统计分析VAP的发生率,并对发生VAP的危险因素实施单因素、多因素logistic分析;采用SPSS19.0软件进行统计分析。结果 703例患者中发生VAP 256例,发生率为36.42%;单因素分析结果显示,年龄、机械通气时间、意识状态、非感染性肺疾病、糖尿病、抗菌药物联用、抗菌药物使用时间与住院时间与VAP的发生有相关性(P<0.05),经logistic多元逐步回归分析,年龄>60岁、机械通气时间>5d、患有非感染性肺疾病、联合使用抗菌药物、抗菌药物治疗持续时间>7d是发生VAP的危险因素。结论 VAP发生的危险因素较多,加强病房管理、正确进行口腔护理、预防误吸和反流、合理使用抗菌药物、加强医护人员培训等措施,可减少VAP的发生。

OBJECTIVE To explore the risk factors for ventilator-associated pneumonia （VAP） and put forward the effective measures for prevention and control of nosocomial infection. METHODS By means of retrospective survey, a total of 703 patients who were treated with ventilators for more than 48 hours and had complete clinical examina- tion data from Jan 2015 to Dec 2015 were recruited as the study objects. The medical records were reviewed to de- termine whether the VAP occurred, the incidence of VAP was statistically analyzed, the univariate analysis and multivariate logistic regression analysis were performed for risk factors for the VAP, and the statistical analysis was conducted with the use of SPSS19.0 software. RESULTS The VAP occurred in 256 of 703 patients, with the incidence rate 36.42%. The result of the univariate analysis indicated that the incidence of VAP was associated with the age, mechanical ventilation duration, state of consciousness, non-infective pulmonary disease, diabetic mellitus, combined use of antibiotics, duration of use of antibiotics, and length of hospital stay （P〈0.05）. The multivariate logistic stepwise regression analysis showed that the risk factors for the VAP included the more than 60 years of age, mechanical ventilation duration more than 5 days, non-infective pulmonary disease, combined use of antibiotics, and duration of antibiotic therapy more than 7 days. CONCLUSION There are a variety of risk fac- tors for the VAP. It is necessary to strengthen the ward management, carry out the correct oral care, prevent the aspiration and regurgitation, reasonably use antibiotics, and enhance the training of health care workers so as to reduce the incidence of VAP.