ICU气管切开患者肺部感染危险因素与护理干预

Risk factors and nursing intervention of pulmonary infection in patients with tracheotomy in ICU

目的探讨综合重症监护室(ICU)气管切开患者肺部感染的危险因素及护理效果。方法采用Logistic回归模型分析2014年1月-2016年5月海南省儋州市人民医院综合ICU的132例行气管切开治疗发生肺部感染患者发生肺部感染的危险因素。对比常规护理组与加强护理组在住ICU时间、临床肺部感染评分(CPIS)、肺功能指标、并发症发生率及死亡率等指标。结果年龄、糖尿病史、气管切开时间延长、白蛋白水平低、留置胃管、长期卧床、抗菌药物使用时间、使用糖皮质激素、使用制酸剂、GCS评分低为气管切开患者肺部感染的影响因素。多元Logistic回归分析显示,糖尿病史、气管切开时间延长、长期卧床、使用糖皮质激素、使用制酸剂、GCS评分低有统计学意义(P<0.05)。加强护理组治疗后住ICU时间、CPIS、白细胞计数、中性粒细胞计数、并发症发生率、死亡率均明显低于常规护理组(P<0.05),FEV1/FVC、FVC/预计值及治疗有效率均明显高于常规护理组(P<0.05)。结论ICU气管切开患者肺部感染与多种因素有关,采取针对性防治措施,加强护理可以降低气管切开患者肺部感染并发症的发生率和死亡率。

Objective To investigate the risk factors and nursing effect of pulmonary infection in patients with tracheotomy in comprehensive intensive care unit（ ICU）. Methods Logistic regression analysis was used to analyze the risk factors of132 cases occurring pulmonary infection after tracheotomy operation from January 2014 to may 2016 in ICU People＇s Hospital in Danzhou City. The indicators of the ICU dwelling time,clinical pulmonary infection score（ CPIS）,pulmonary function and complications and mortality were compares and analyzed between inpatients in routine nursing group and in strengthen nursing group. Results Age,history of diabetes,prolonged tracheotomy,low albumin levels,indwelling gastric tube,long-term bed,antibiotic use time,the use of glucocorticoid,the use of antacids,lower GCS score were the influencing factors of pulmonary infection in patients with tracheotomy. Multiple Logistic regression analysis showed that the history of diabetes,prolonged tracheotomy,long-term bed,the use of glucocorticoids,the use of antacids,lower GCS score were statistically significant（ P〈0. 05）. The live ICU time,CPIS,white blood cell count,neutrophil count,complications and mortality in strengthen nursing group were significantly lower than those of the routine nursing group（ P〈0. 05）. The FEV1/FVC,FVC/expected value and the treatment efficiency in strengthen nursing group after treatment were significantly higher than those of the routine nursing group（ P〈0. 05）. Conclusion Pulmonary infection of ICU tracheotomy patients is related with a variety of factors. So taking preventive measures aimly,strengthening nursing can reduce the incidence and mortality rate of pulmonary infection in patients with tracheotomy.