ICU脑卒中患者呼吸机相关性肺炎危险因素分析

Risk Factors of Ventilator-associated Pneumonia in Stroke Patients in ICU

【目的】探讨ICU脑卒中患者发生呼吸机相关性肺炎的危险因素,为改善脑卒中患者预后提供依据。【方法】回顾性分析安徽省立医院南区重症医学科2016年6月至2018年6月119例机械通气脑卒中患者的临床资料,依据是否发生呼吸机相关性肺炎(VAP),将患者分为VAP组60例及非VAP组(对照组)59例。比较两组患者性别、年龄、基础疾病、白蛋白、淋巴细胞绝对值、GCS评分、APACHEⅡ评分、吞咽功能、是否手术治疗及广谱抗生素、激素、血管活性药物、镇静剂及抑酸剂使用情况。对两组患者差异有统计学意义的指标进行多因素回归分析,分析ICU脑卒中患者机械通气时发生VAP的危险因素。【结果】脑卒中VAP组患者的年龄、APACHEⅡ评分、GCS评分、伴有吞咽困难、合并基础疾病、使用广谱抗生素、镇静药及抑酸剂与对照组比较差异有统计学意义(P<0.05)。VAP组患者的性别、白蛋白、淋巴细胞绝对值、是否手术治疗、广谱抗生素、激素、血管活性药物使用与对照组比较差异无统计学意义(P>0.05)。多因素回归分析显示脑卒中VAP的发生与高龄、合并慢性基础病、吞咽功能障碍、低GCS评分及高APACHEⅡ评分、镇静及抑酸剂应用使用有关。【结论】高龄、合并慢性基础病、吞咽功能障碍、低GCS评分及高APACHEⅡ评分、镇静及抑酸剂应用是脑卒中患者发生VAP的危险因素,应加以预防。

【Objective】To explore the risk factors of ventilator-associated pneumonia in ICU stroke patients in order to provide knowledge for improving the prognosis of stroke patients.【Methods】Clinical data of 119 patients with mechanical ventilation stroke from June 2016 to June 2018 in the intensive care department of the southern district of Anhui provincial hospital were retrospectively analyzed. Patients were divided into 60 patients in the VAP group and 59 patients in the non-vap group (control group) according to the occurrence of ventilator-associated pneumonia (VAP). Gender, age, underlying disease, albumin, lymphocyte absolute value, GCS scores, APACHEⅡ scores, swallowing function, surgical treatment, broad-spectrum antibiotics, hormones, vasoactive drugs, sedatives and acid inhibitors were compared between the two groups. Multivariate regression analysis was performed on the indicators with statistically significant differences between the two groups to analyze the risk factors of VAP during mechanical ventilation in ICU stroke patients.【Results】Age, APACHEⅡ scores, GCS scores, dysphagia, accompaniment with chronic diseases, use of broad-spectrum antibiotics, sedatives and antacids in patients with stroke in the VAP group showed statistically significant differences from the control group (P<0.05). There was no statistically significant difference between the VAP group and the control group in terms of gender, albumin, lymphocyte absolute value, surgical treatment or not, broad-spectrum antibiotics, hormones and vasoactive drugs (P>0.05). Multivariate regression analysis showed that the occurrence of stroke VAP was associated with advanced age, chronic underlying disease, dysphagia, low GCS scores and high APACHEⅡ scores, sedation and acid suppressant application.【Conclusions】 Elderly age, accompaniment with chronic diseases, swallowing dysfunction, low GCS scores and high APACHEⅡ scores, use of sedatives and antacids are risk factors for VAP in stroke patients and should be prevented.