重症监护室呼吸机相关肺炎患者的死亡因素分析

Analysis on Death Risk Factors of ICU Patients with Ventilator Associated Pneumonia

目的:观察重症监护室(ICU)内呼吸机相关肺炎(VAP)患者死亡影响因素。方法:研究对象为我院ICU病房进行治疗的机械通气时间超过48h的328例VAP患者,分析患者的基本临床资料,使用单变量和多变量分析确定入组患者死亡的危险因素,观察慢性阻塞性肺部疾病(COPD)对患者生存的影响。结果:非COPD患者(n=229)ICU死亡率显著低于COPD患者(n=99)(42.8%vs 59.6%,P=0.017)。非COPD患者机械通气时间和ICU住院时间的中位数分别为27(16-42)d和35(29-59)d,而COPD患者分别为为32(17-68)d和40(22-72)d(P>0.05),二者没有显著差异,非COPD患者与严重COPD患者(GOLD IV期)的机械通气时间和ICU住院时间有显著差异(P=0.002与0.03)。多变量分析表明COPD(OR=2.59,95%CI:1.34-5.03)、简化急性生理评分II(SAPS II)(OR=1.03,95%CI:1.02-1.05)以及休克(OR=3.73,95%CI:1.89-7.40)是ICU死亡的独立危险因素。结论:COPD、SAPS II以及休克均与ICU内VAP患者的死亡有关。

Objective： To observe the death risk factors of ICU patients with ventilator-associated pneumonia （VAP）, Methods 328 VAP patients were enrolled into this research with treatment in ICU wards for mechanical ventilation more than 48h. The baseline clinical data were analyzed and the risk factors for ICU death were identified by using univariate and multivariable analyses methods. The effects of chronic obstructive pulmonary disease （COPD） on the survival of patients were also observed. Results： ICU mortality in Non COPD group （n=229） was significantly lower than that in COPD group （n=99） （42.8% vs. 59.6%, p=0.017）. The median of mechanical ventilation time and ICU stay （IQR） in Non COPD group were 27 （16-42） d and 35 （29-59） d respectively, and were respectively 32 （17-68） d and 40 （22-72） d in COPD group, with no significant difference between the two groups （P 〉0.05）. However, there was significant difference in mechanical ventilation time and ICU stay between severe COPD patients （GOLD stage IV） and non COPD patients （P=0.002, 0.03）. Multivariate analysis results showed that COPD （OR=2.59, 95% CI： 1.34-5.03）, simplified acute physiology score II （SAPS II） （OR=1.03,95% CI： 1.02-1.05） and shock（OR=3.73, 95% CI： 1.89-7.40） were independent risk factors for ICU death. Conclusion： COPD, shock and ICU were associated with patients with VAP in ICU.