ICU患者呼吸机相关肺炎危险因素logistic回归分析与干预效果分析

Logistic regression analysis of risk factors and intervention effect of ventilator associated pneumonia in ICU patients

目的:探讨重症监护病房(ICU)机械通气患者发生呼吸机相关肺炎(VAP)的危险因素与干预措施的效果。方法:采用前瞻性研究,对2011-01—2016-12期间入住ICU并接受机械通气患者进行VAP监测,分析发生VAP患者的相关危险因素及致病菌分布;采用SPSS19.0统计软件对数据进行分析,计数资料比较用χ2检验或校正χ2检验及Fisher's精确概率法;对诱发VAP的危险因素分析采用单因素与多因素logistic回归分析。结果:共监测2713例,发生VAP 648例,发生率为23.88%,VAP千日感染率为17.00‰,病死率为30.40%。共检出致病菌674株,其中革兰阴性菌633株占93.92%,革兰阳性菌39株占5.79%,真菌2株占0.30%;前4位致病菌分别为鲍曼不动杆菌39.76%(268/674)、铜绿假单胞菌20.77%(140/674)、肺炎克雷伯菌10.09%(68/674)和金黄色葡萄球菌5.79%(39/674)。单因素及多因素logistic回归分析显示,无声门下吸引、有意识障碍、应用免疫制剂、血清白蛋白低、基础疾病多、机械通气时间长、住ICU时间长、急诊置管、APACHEⅡ评分高、置管前未行口腔护理是VAP发生的独立危险因素(P<0.05)。持续干预期与基线调查期相比,ICU患者呼吸机使用率、VAP发生率及千日感染率呈逐年下降趋势。结论:ICU机械通气患者VAP发生的危险因素较多,实施前瞻性目标监测加持续的集束化干预防控措施,能有效降低VAP发生率。

Objective：To investigate the risk factors and intervention effect of ventilator associated pneumonia in ICU patients undergoing mechanical ventilation.Method：Prospective study was adopted,VAP monitoring was performed in the ICU and mechanical ventilation patients from January 2011 to December 2016,and the relevant risk factors and pathogen distribution of VAP patients were analyzed;the distribution of pathogens and the related risk factors were compared by means of chi-square test or corrected chi-square test and Fisher＇s.exact probability test.The univariate analysis and multivariate analysis were carried out for the influencing factors for the VAP.Result：Of 2713 ICU patients undergoing the mechanical ventilation,648 had VAP with the incidence rate of 23.88%.The daily infection rate of VAP was 17.00‰,and the fatality rate was 30.40%.A total of 674 strains of pathogens were isolated,including 633（93.92%）strains of gram-negative bacteria,39（5.79%）strains of gram-positive bacteria,and 2（0.30%）strains of fungi.The first four pathogenic Acinetobacter baunannii 39.76%（268/674）,of pseudomonas aeruginosa 20.77%（140/674）,klebsiella pneumoniae 10.09%（68/674）and staphylococcus aureus 5.79%（39/674）.The univariate analysis and multivariate logistic regression analysis showed that the independent risk factors for the VAP included the more Silent door attract,conscious disorder,application of immune preparations,low serum albumin,basic diseases,long time of mechanical ventilation,live long time in the ICU,emergency catheter,APACHEⅡ high score,no oral care before catheter is independent risk factors for VAP occurs（P〈0.05）.Conclusion：There are a variety of risk factors for the VAP in the ICU patients undergoing mechanical ventilation.The implementation of proactive target monitoring and continuous cluster intervention prevention and control measures can effectively reduce the incidence of VAP.