神经外科呼吸机相关性肺炎并发血流感染的危险因素

Factors related to blood stream infection in neurosurgical patients with ventilator-associated pneumonia

目的探讨神经外科呼吸机相关性肺炎(VAP)并发血流感染的危险因素。方法回顾性分析2013年4月至2019年3月收治的387例神经外科VAP的临床资料,采用多因素logistic回归分析检验血流感染的危险因素。结果387例VAP中,112例发生血流感染,血流感染率为28.94%。112例血流感染共分离出病原菌124株,以革兰阴性菌为主,前五位病原菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌、鲍曼不动杆菌。多因素logistic回归分析结果显示迟发型感染、急性生理与慢性健康量表Ⅱ评分≥15分、降钙素原>2 ng/ml、机械通气时间≥7 d、使用糖皮质激素、血糖>11.1 mmol/L、气管切开等7个因素为神经外科VAP并发血流感染的独立危险因素。结论及时评估早期拨管、重点关注病情严重病人、控制血糖、合理减少糖皮质激素使用、减少气管切开,减少迟发型VAP等措施,有助于降低可VAP血流感染率;降钙素原监测可早期预测VAP血流感染。

Objective To analyze the factors related to blood stream infection(BSI)in the neurosurgical patients with ventilatorassociated pneumonia(VAP)in order to put forward its intervenient measures.Methods The clinical data of 387 neurosurgical patients with VAP from April,2013 to March,2019 were analyzed retrospectively.Of these 387 patients,112 suffered from BSI and 275 did not.The factors related to BSI were statistically analyzed.Results The rate of occurrence of BSI was 28.94%in these 387 patients.The multivariate logistic regression analysis showed that the independent risk factors related to BSI in the neurosurgical patients with VAP included the delayed VAP,acute physiology and chronic health evaluationⅡscores≥15 points,serum level of procalcitonin≥2 ng/ml,mechanical ventilation time≥7 d,use of glucocorticoid,blood sugar≥11.1mmol/L and tracheotomy.Conclusion In order to reduce BSI in the neurosurgical patients with VAP,we should timely evaluate the main measures to prevent BSI such as early catheterization,focusing on patients with severe illness,controlling blood glucose,reasonable use of glucocorticoid,reducing tracheotomy and reducing the occurrence of delayed VAP.The serum level of procalcitonin may be helpful to early prediction of BSI in the neurosurgical patients with VAP.