早期肠内营养与重症监护病房机械通气患者呼吸机相关性肺炎的巢氏病例对照研究

Multivariate analysis on the association between early enteral nutrition and ventilator -associated pneumonia

目的 研究重症监护病房（ICU）内机械通气患者的呼吸机相关性肺炎（VAP）与早期肠内营养的关联。方法 研究队列为2012-01~2016-03收住我院ICU的所有建立人工气道的患者，通过医院感染实时监测系统，实时追踪所有机械通气患者发生VAP的情况，同时监测患者入ICU后开展早期肠内营养的情况，采用巢式病例对照研究设计，应用Logistic回归分析，比较发生VAP与早期肠内营养的关联。结果 按照1∶3原则共有32例VAP及105例无VAP的ICU患者进入研究，研究组中仅有11例开展了早期肠内营养，而对照组105例中有68例开展了早期肠内营养，两组在年龄、性别、入院诊断和基础疾病间的差异无统计学意义（P〉0.05）。两组在入院天数（38.09±23.43；26.13±12.97）、入住ICU天数（26.38±20.65；15.75±7.667）、机械通气天数（22.41±19.93；11.22±5.64）的差异有统计学意义（P＜0.05）。早期肠内营养与VAP的OR值是0.285,早期肠内营养与VAP呈负相关。结论 ICU内机械通气的患者中，开展早期肠内营养可以有效地降低VAP发生的风险，从而缩短其抗菌药物使用天数，减少机械通气时间及住院时间。

Objective To observe on the association between early enteral nutrition and ventilator- associated pneumonia（VAP）. Methods The study cohort was all artificial airway patients who admitted in ICU from January 2012 to March 2016 in our hospital, with the help of the hospital infection real time monitoring system, we recorded the incidence of ventilator associated pneumonia in all patients with mechanical ventilation. At the same time, we monitored the patients who have early enteral nutrition. Nested case -control study and Logistic regression were used to compare the relationship between VAP and early enteral nutrition. Results According to the ratio of 1 ： 3, the total of 32 VAP patients and 105 non - VAP patients were enrolled in the study. In the study group, only 11 cases had early enteral nutrition, while 68 in the control group had early enteral nutrition. No statistically significant differences were found between the two groups at age and gender. There was no significant difference between the two groups in the diagnosis of admission and underlying diseases. Between the two groups of patients, admission days （ 38.09 ±23.43 ; 26.13 ± 12.97 ）, ICU stay （ 26.38 ±20.65 ; 15.75 ±7. 667 ）, mechanical ventilation days （22.41 ±19.93 ; 1 1.22 ±5.64） difference was statistically significant （ P 〈 0.05 ）. The OR value of early enteral nutrition and VAP was 0.285. Early enteral nutrition was negatively correlated with VAP. Conclusion Early enteral nutrition in patients with ICU mechanical ventilation can effectively reduce the risk of developing VAP, early enteral nutrition can shorten the number of days of antibiotic use, reduce the duration of mechanical ventilation and hospital stay.