ICU老年患者早发和晚发呼吸机相关性肺炎危险因素比较分析

Risk Factors of the Elderly Patients in ICU with Early and Late Onset of Ventilator Associated Pneumonia

目的分析重症医学科(ICU)老年患者早发及晚发呼吸机相关性肺炎(VAP)的危险因素,探讨老年VAP的预防和控制措施。方法将189例ICU老年患者分为早发VAP(EOP)及晚发VAP(LOP)组,进行VAP危险因素及病原学分析。结果 EOP和LOP的发病率分别为32.18%和51.96%,GCS评分在8~12分易于发生EOP,GCS评分在4~7分则易于发生LOP,两者差异有显著性。EOP组的独立发病危险因素是APACHEⅡ评分高、COPD史和机械通气时间延长;LOP的独立发病危险因素是COPD史、机械通气时间延长、血清白蛋白<30g/L和意识障碍;两组共同的危险因素是机械通气时间延长和COPD史。EOP和LOP的致病菌主要为G-杆菌。结论老年患者VAP发病率较高,尽量避免LOP的危险因素,采取早诊治等措施降低老年患者VAP发病率。

Objective To explore risk factors and preventive measurement for early onset VAP （EOP ） and late onset VAP（LOP） of elderly patients in the ICU. Methods 189 elderly patients in ICU were divided into EOP group and LOP group, and risk factors of the two groups were analyzed. Results The incidence rates of EOP and LOP were 32. 18% and 51.96% . EOP occurred in GCS score from 8 to 12, and LOP in GCS score from 4 to 7. The independent risk factors for EOP group were high APACHE II score, COPD history and prolonged mechanical ventilation time; while for LOP were COPD his-tory, prolonged mechanical ventilation time,albumin 〈 30 g/L and consciousness disorder. The common risk factors of the two groups were prolonged mechanical ventilation time and COPD history. The pathogenic bacteria of the two groups were mainly gram negative bacillus. Conclusion The incidence of VAP in elderly patients is high and various factors contributed to VAP. The incidence of VAP in elderly patients can be reduced by avoiding risk factors for LOP and taking early diagnosis.