呼吸机相关肺炎在多中心不同场所ICU的危险因素研究

Multicenter study on risk factors for ventilator-associated pneumonia in intensive care unites

目的了解重症监护病房(ICU)呼吸机相关肺炎(VAP)的发病率及相关危险因素,为临床制定预防VAP防控措施提供依据。方法采用统一设计、多中心合作的方法,对部队19所三级甲等综合医院6个类型27个ICU开展前瞻性监测,监测对象为2015年6月-2016年5月所有入住ICU并插管使用呼吸机的患者。结果共监测患者3488例,发生VAP393例,发病率为11.27%;住院总日数为128572d,插管总日数40114d,VAP千日感染率为9.80‰,呼吸机使用率为31.20%;不同类型ICU VAP发病率为4.91%~26.95%,千日感染率为5.74‰~34.79‰;病死率为25.45%,治愈率为2.80%;单因素结果显示,VAP相关危险因素与年龄、住ICU天数、基础疾病数量、机械通气时间、置管次数和口腔清洁次数有关(P<0.05);多因素logistic回归分析结果显示,住ICU天数、机械通气时间、置管次数是VAP发生的独立危险因素;共检出446株病原菌,其中革兰阴性菌占89.01%,革兰阳性菌占7.17%,真菌占3.81%。结论通过开展"医院感染预防与控制能力建设"项目,明确发生VAP的相关危险因素,有针对性地制定防控措施和规范操作流程。

OBJECTIVE To understand the morbidity rate of ventilator-associated pneumonia（VAP）in intensive care unit（ICU）and explore the related risk factors so as to put forward the prevention and control measures for VAP.METHODS By means of unified design and multicenter collaboration,aprospective monitoring was conducted for 27 ICUs of 6types in 19 tertiary hospitals,and all of the patients who were hospitalized the ICU and were intubated for mechanical ventilation from Jun 2015 to May 2016 were recruited as the monitoring objects.RESULTS Of 3488 patients who were monitored,393 had VAP,with the morbidity rate 11.27%.The total length of hospital stay was 128572 days,the total length of catheterization treatment was 40114 days,the thousand-day infection rate of VAP was 9.80‰,and the utilization rate of ventilators was 31.20%.The morbidity rate of VAP varied from 4.91% to 26.95%in the ICUs,the thousand-day infection rate varied from 5.74‰ to34.79‰,the mortality rate was 25.45%,and the cure rate was 2.80%.The result of univariate analysis indicated that the related risk factors for the VAP included the age,length of ICU stay,number of underlying diseases,mechanical ventilation duration,time of catheterization,and times of oral cleaning（P〈0.05）.The result of multivariate logistic regression analysis showed that the length of ICU stay,mechanical ventilation duration,and time of catheterization were the independent risk factors for the VAP.A total of 446 strains of pathogens were isolated,of which 89.01% were gram-negative bacteria,7.17% were gram-positive bacteria,and 3.81% were fungi.CONCLUSIONIt is necessary to make clear of the related risk factors for the VAP by conducting the＇nosocomial infection prevention and control capability building＇program so as to take targeted prevention and control measures and follow standard operation procedures.