呼吸机相关事件监测及预后相关因素分析

Monitoring of ventilator-associated events and related factors of prognosis

目的前瞻性监测重症监护病房(ICU)呼吸机相关事件(VAE)的发生情况,了解VAE的发生率、与预后的相关性、与传统呼吸机相关性肺炎(VAP)的相关性,进而探讨VAE在我国的适用性。方法选择2017年1-12月本院年龄≥18岁、有创机械通气(IMV)≥4天的符合纳入标准的患者428例进行监测,统计VAE发生率;并根据是否发生VAE分为VAE组30例和非VAE组398例,归纳VAE的预后相关因素;同时采用Kappa一致性检验,判断VAE与传统VAP的一致性。结果 428例患者总住院日为11 079天,总IMV天数为3 982天,机械通气次数523次。发生VAE 30例,例次发生率为7.01%(30/428),日发生率为2.71‰(30/11 079),以机械通气日为分母发生率为7.53‰(30/3 982),以机械通气次数为分母发生率为5.74%(30/523)。IMV天数、入住ICU天数、总费用、出ICU时死亡是VAE预后的相关因素(P<0.05)。Kappa一致性检验结果显示,VAE和传统VAP的相关性较差。结论 VAE的诊断标准客观量化、与不良预后相关性较大,但对于传统VAP的辨识度不高,在我国的适用性需要进一步证实。

OBJECTIVE To understand the incidence of ventilator-associated event（VAE）,correlation with prognosis and the correlation with conventional ventilator associated pneumonia（VAP）by prospectively monitoring VAE in an intensive care unit（ICU）,and discuss the applicability of VAE in China.METHODS A total of 428 cases of patients with the age≥18 years old and invasive mechanical ventilation（IMV）≥4 days in our hospital from Jan.2017 and Dec.2017 were selected,and the incidence of VAE was calculated.The patients were divided into VAE group of 30 cases and non-VAE group of 398 cases according to whether they had VAE or not.The prognostic factors of VAE were statistically analyzed.At the same time,Kappa consistency test was used to judge the consistency between VAE and traditional VAP.RESULTS The total hospitalization days of 428 cases of patients were 11079 days,the total number of IMV days was 3982 days,and the number of mechanical ventilation times was 523 times.VAE occurred in 30 cases,the incidence was 7.01%（30/428）,2.71（30/11 079）per 1000 hospitalization days,7.53‰（30/3 982）per 1000 ventilation days and 5.74%（30/523）per episode of mechanical ventilation.The duration of IMV,length of ICU stay,total cost,and mortality when patients left ICU were risk factor for prognosis of patients with VAE（P〈0.05）.Kappa consistency test results showed that the correlation between VAE and traditional VAP was poor.CONCLUSIONThe diagnostic standard of VAE is objectively quantified,and has a great correlation with poor prognosis.However,the recognition rate of traditional VAP is not high,and its applicability in China needs further confirmation.