ICU患者呼吸机相关性肺炎的危险因素及防治措施

Risk factors and preventive measures of ventilator-associated pneumonia in ICU patients

目的观察分析重症监护病房(intensive care unit,ICU)患者呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)发生的危险因素及防治措施。方法选取我院2016年3月~2018年3月ICU收治的实施机械通气治疗患者为研究对象,根据VAP诊断标准分为观察组(VAP患者)及对照组(未发生VAP患者),观察并对比两组相关危险因素、临床特点、病原菌具体分布情况及预后。结果观察组留置胃管、深静脉导管、抑酸剂与H2的应用、高龄、机械通气时间>3 d、营养不良、肾上腺皮质激素应用、慢性肺疾病等危险因素占比均高于对照组,差异有统计学意义(P<0.05);进行多因素Logistic回归分析表明,留置胃管、深静脉导管、抑酸剂与H2的应用、高龄、机械通气时间>3 d、营养不良、肾上腺皮质激素应用、慢性肺疾病是ICU患者机械通气VAP发生的独立影响因素。观察组患者病原菌培养菌株为235株,其中146株(62.1%)革兰阴性菌(G-杆菌),37株(15.7%)革兰阳性菌(G+球菌),其余52株(22.1%)为真菌;观察组死亡率(34.2%)高于对照组(2.6%),差异有统计学意义(P<0.05)。G-杆菌对头孢他啶、亚胺培南/西司他汀及哌拉西林/他唑巴坦有着相对较低的耐药性。G+球菌中以表皮葡萄球菌及金黄色葡萄球菌为主,且二者对万古霉素的敏感性为100.0%。结论 ICU使用机械通气治疗患者VAP发生危险因素多,应根据患者具体情况尽量将机械通气时间减少,对ICU内消毒隔离等基础措施进行加强,以有效控制VAP发生,降低患者死亡风险。

Objective To observe and analyze the risk factors and prevention measures of ventilator-associated pneumonia(VAP) in patients in intensive care unit(ICU). Methods Patients who underwent mechanical ventilation in ICU of our hospital from March 2016 to March 2018 were enrolled in the study. They were divided into observation group(VAP patients) and control group(no VAP patients) according to the VAP diagnostic criteria. The risk factors, clinical features, specific distribution of pathogens and prognosis of the two groups were observed and compared. Results In the observation group, proportions of risk factors including the application of gastric tube, deep vein catheter, antacid and H2, advanced age, mechanical ventilation time >3 d, malnutrition, application of adrenal cortex hormones, and chronic lung disease were higher than those of the control group, and the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed indwelling gastric tube, deep vein catheter, antacid and H2 application, advanced age, mechanical ventilation time>3 d, malnutrition, adrenal cortical hormone application, and chronic lung diseases were independent influencing factors for the occurrence of mechanical ventilation VAP in ICU patients. The number of pathogen culture strains of the observation group was 235, of which 146(62.1%) were Gram-negative bacteria(G-bacillus), 37(15.7%) were Gram-positive bacteria(G+cocci), and the remaining 52(22.1%) were fungus. The mortality rate of the observation group(34.2%) was higher than that of the control group(2.6%), and the difference was statistically significant(P<0.05). G-bacilli had relatively low resistance to ceftazidime, imipenem statin and piperacillin tazobactam. G+cocci were mainly Staphylococcus epidermidis and Staphylococcus aureus, and their sensitivity to vancomycin was 100.0%. Conclusion There are many risk factors for VAP in patients using mechanical ventilation in ICU.The mechanical ventilation time should be reduced as much as possible according to the patients’ specific conditions.The basic measures such as disinfection and isolation in the ICU should be strengthened to effectively control the occurrence of VAP and reduce the risk of death.