老年患者呼吸机相关性肺炎发生率相关因素及治疗结局分析

Related Factors and Treatment Outcome of Ventilator-associated Pneumonia in Elderly Patients

目的:分析老年患者发生呼吸机相关性肺炎(VAP)的相关因素及治疗结局。方法:选取某院2016年10月~2017年收治的98例行机械通气治疗的老年患者临床资料进行回顾性分析,分析患者发生呼吸机相关性肺炎的相关危险因素,并进行Logistic多因素回归分析,统计患者的治疗结局。结果:98例患者中,共36例患者发生VAP,发生率为36.7%。根据单因素分析表明,患者非感染性肺疾病、意识状态、机械通气时间、联用抗菌药物、住院时间、抗菌药物持续治疗时间以及合并慢性疾病等是影响老年患者发生VAP的相关危险因素(P<0.05);经Logistic多因素回归分析表明,患者有非感染性肺疾病、机械通气时间>5d、联用抗菌药物、抗菌药物持续治疗时间>7d是导致老年患者发生VAP的重要危险因素(P<0.05)。老年VAP患者死亡率(36.1%)显著高于非VAP患者(11.3%),差异有统计学意义(P<0.05)。结论:老年患者发生VAP的相关危险因素较多,临床应加强病房管理,合理应用抗菌药物,积极预防高危因素,降低患者死亡率,改善预后。

Objective：To analyze the related factors and treatment outcome of ventilator-associated pneumonia（VAP）in elderly patients.Methods：The clinical data of 98 elderly patients with mechanical ventilation treated in a hospital from October 2016 to 2017 were analyzed retrospectively to analyze the risk factors of ventilator-associated pneumonia in patients,and the logistic multivariate regression analysis was carried out.Then the patients＇ treatment outcome were recorded.Results：Among the 98 patients,VAP occurred in 36 patients and the incidence was 36.7%.According to univariate analysis,patients with non-infectious pulmonary diseases,state of consciousness,time of mechanical ventilation,combined use of antibiotics,hospital stay,the duration of continuous antimicrobial therapy and associated chronic diseases were the risk factors associated with VAP in elderly patients（P〈0.05）.Logistic multivariate regression analysis showed that patients with noninfectious pulmonary disease,mechanical ventilation 〉5 days,combination of antibiotics,duration of antimicrobial treatment for 〉7 days and so on were the important risk factors of VAP in elderly patients（P〈0.05）.The mortality of elderly patients with VAP（36.1%）was significantly higher than that of nonVAP patients（11.3%）,the difference was statistically significant（P〈0.05）.Conclusion：There are many risk factors related to the occurrence of VAP in elderly patients.The management of ward should be strengthened,the antibiotics should be used rationally,the high risk factors should be actively prevented,the mortality rate of patients should be reduced,and the prognosis should be improved.