肿瘤外科患者呼吸机相关性肺炎的危险因素分析

Risk factors of ventilator-associated pneumonia in surgical oncologic patients in intensive care unit:a retrospective study

目的探讨肿瘤外科患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)发生的危险因素。方法回顾性分析2013年6月1日至2015年12月31日于本院重症医学科(intensive care unit,ICU)接受机械通气大于48小时的肿瘤外科患者的临床资料,分析发生VAP的危险因素。结果 64例机械通气患者中,有25例(39.06%)发生VAP,每1000个插管日发生VAP例数为3.13例。VAP患者院内病死率显著高于非VAP患者(40.0%vs 5.1%,P=0.001)。单因素分析发现,ICU住院时间[(33.72±33.35)天vs(6.81±4.20)天,P<0.001]、机械通气时间[(586.60±582.76)小时vs(115.92±71.38)小时,P<0.001]、术前抗生素使用>48小时(17.2%vs 6.3%,P=0.002)、气管切开(32.8%vs 10.9%,P<0.001)、血流感染(14.1%vs 6.3%,P=0.016)、使用丙泊酚剂量[(7.54±8.11)g vs(1.95±3.66)g,P<0.001]及胃肠内营养(32.8%vs 12.5%,P<0.001)是VAP发生的危险因素。多因素分析发现仅胃肠内营养(P=0.013,OR=17.758,95%CI:1.821~173.120)是VAP发生的独立危险因素。结论 VAP增加机械通气肿瘤外科患者的院内病死率。胃肠内营养支持是接受机械通气肿瘤外科患者VAP发生的独立危险因素。

Objective To investigate the risk factors of ventilator-associated pneumonia （VAP） in surgical oncologic patients admitted to intensive care unit （ICU）. Method We performed a retrospective study at surgical ICU between June, 2013 and December, 2015 in surgical oncologic patients who were intubated for more than 48 hours, and analyzed the risk factors of VAP. Result Sixty four patients received mechanical ventilation for more than 48 hours. VAP developed in 25 patients （39.06%）. There were 3.13 cases per 1,000 days of intubation. In-hospital death rate was significantly higher in VAP group than that in non-VAP group （40.0% vs 5.1%; P=0.001）. Univariable analysis demonstrated that compared with non-VAP group, VAP group was associated with longer hospital length of stay [（33.72 _33.35）d vs （6.81 _4.20）d, P〈0.001）], longer duration of mechanical ventilation [（586.60± 582.76） h vs （115.92 ±71.38 ）h, P〈0.001], more prior use of antibiotics longer than 48 hours （17.2% vs 6.3%, P=0.002）, more tracheotomies （32.8% vs 10.9%, P〈 0.001）, more bloodstreams （14.1% vs 6.3%, P=0.016）, more dosage of propofol [（7.54 ± 8.11）g vs （1.95 ± 3.66）g, P〈 0.001], and more enteral feedings （32.8% vs 12.5%, P〈0.001）. Multivariable analysis demonstrated that enteral feeding was the only independent risk factor of VAP （P=0.013; OR=17.758, 95%CI： 1.821± 173.120）. Conclusion VAP was associated with increased in-hospital death in ventilated surgical oncologic patients. Enteral feeding was the risk factor of VAP in surgical oncologic patients receiving mechanical ventilation.