儿童监护室患儿呼吸机相关性肺炎感染的危险因素分析与护理预防措施

Analysis of risk factors and nursing precautions for ventilator-associated pneumonia infection in children in intensive care unit

目的研究儿童监护室患儿呼吸机相关性肺炎(VAP)感染的危险因素。方法选取2013年1月-2018年1月本院儿童监护病房收治的342例患儿,其中112例确诊为VAP感染,采用卡方检验和Logistic回归分析确定儿童监护室患儿VAP感染的危险因素。结果 342例患儿中112例确诊为VAP感染,感染率为32.75%,检出128株病原菌,其中革兰阴性菌94株,占73.44%,革兰阳性菌34株,占21.88%。革兰阳性菌金黄色葡萄球菌和表皮葡萄球菌对青霉素类抗生素耐药率最高,对万古霉素敏感;革兰阴性菌肺炎克雷伯菌和铜绿假单胞菌对头孢呋辛耐药率最高,对亚胺培南敏感。单因素结果分析和多因素Logistic分析,机械通气时间、贫血、入住监护室时间、使用抗菌药物、插管次数、白蛋白水平及使用激素是儿童监护室患儿发生VAP的独立危险因素。结论革兰阴性菌是VAP患儿感染的主要病原菌,临床中针对危险因素采取预防措施可以控制VAP感染的发生率。

Objective To study the risk factors of ventilator-associated pneumonia ( VAP) infection in children in intensive care units. Methods A total of 342 children admitted to our intensive care unit from January to February 20,2013 were enrolled. Of these,112 were diagnosed with VAP infection. Chi-square test and Logistic regression analysis were used to determine the risk factors of VAP infection in children in the intensive care unit. Results Of the 342 children,112 were diagnosed with VAP infection. The infection rate was 32. 75%. 128 pathogens were detected,of which 94 were Gram-negative bacteria,accounting for 73. 44%,and 34 were Gram-positive bacteria,accounting for 21. 88%. Gram-positive bacteria Staphylococcus aureus and Staphylococcus epidermidis had the highest resistance to penicillin antibiotics and were sensitive to vancomycin;resistance rates of Gram-negative bacteria Klebsiella pneumoniae and Pseudomonas aeruginosa to cefuroxime were the highest,and sensitive to imipenem. Univariate outcome analysis and multivariate Logistic analysis,mechanical ventilation time,anemia,in-patient room time,use of antibiotics,number of intubations,albumin levels,and hormone use were independent risk factors for VAP in children in intensive care units. Conclusion Gram-negative bacteria is the main pathogen causing infection in children with VAP. Precautions against risk factors can be used in clinical practice to control the incidence of VAP infection.