舌癌根治术患者AICU恢复期并发呼吸机相关性肺炎危险因素及感染致病菌群的调查

Investigation on risk factors of ventilator associated pneumonia and infection of pathogenic bacteria flora in patients with tongue cancer radical operation undergoing the recovery period of AICU

目的探讨舌癌根治术患者麻醉重症监护室(AICU)恢复期并发呼吸机相关性肺炎(VAP)危险因素及感染致病菌群分布情况。方法选择2018年3月至2019年3月本院行舌癌根治术治疗的284例舌癌患者作为研究对象,收集患者临床资料,统计AICU恢复期VAP发生率,经logistic多元回归分析确定AICU恢复期VAP发生危险因素,并经细菌培养鉴定了解VAP感染致病菌群分布情况。结果284例舌癌根治术患者AICU恢复期并发VAP 17例,发生率是5.99%。单因素分析显示,舌癌根治术患者AICU恢复期并发VAP与患者意识状态、年龄、侵入性操作>3次、APACHEⅡ评分、联合应用抗菌药物、湿化器微生物定植、误吸存在相关性(P<0.05);舌癌根治术患者AICU恢复期并发VAP与患者性别、合并基础疾病、口咽部微生物定植无相关性(P>0.05)。多因素logistic回归分析显示患者意识状态、年龄≥60岁、侵入性操作>3次、APACHEⅡ评分≥18分、联合使用抗菌药物、湿化器微生物定植、误吸为舌癌根治术患者AICU恢复期并发VAP独立危险因素。结论舌癌根治术患者AICU恢复期并发呼吸机相关性肺炎与意识状态、高龄、联合使用抗菌药物、湿化器微生物定植及误吸等因素有关,且致病菌主要为革兰阴性菌;合理给予患者抗菌药物治疗,并及早开展针对性护理管理非常关键。

Objective To investigate the risk factors of ventilator associated pneumonia(VAP)and the distribution of pathogenic bacteria flora in patients with tongue cancer undergoing the recovery period of AICU.Methods We selected 284 cases of patients with tongue cancer who underwent radical operation of tongue cancer in our hospital from March 2018 to March 2019 as the study subjects.The clinical data of the patients were collected to count the incidence rate of VAP in the recovery period of AICU,and the risk factors of VAP occurrence in the recovery period of AICU was determined by logistic multiple regression analysis,and the distribution of pathogenic bacteria flora in VAP infection was uncovered through bacterial culture identification.Results There were 17 cases of concurrent VAP in 284 cases of patients with tongue cancer radical operation undergoing the recovery period of AICU,with the incidence rate of 5.99%.Univariate analysis showed that the concurrent VAP in patients with tongue cancer radical operation undergoing the recovery period of AICU was related to the patient’s status of consciousness,age,invasive procedures>3 times,APACHE II score,combined use of antibacterial drugs,humidifier microbiological colonization,and aspiration(P<0.05).There was no correlation between concurrent VAP in patients with tongue cancer radical operation undergoing the recovery period of AICU and patients’gender,combined basic diseases,and oropharyngeal microbial colonization(P>0.05).Multivariate logistic regression analysis showed that the patients’status of consciousness,age≥60 years,invasive procedures>3 times,APACHE II score≥18 points,combined use of antibacterial drugs,humidifier microbiological colonization,and aspiration,which were the independent risk factors for concurrent VAP in patients with tongue cancer radical operation undergoing the recovery period of AICU.Conclusion The concurrent VAP of patients with tongue cancer radical operation undergoing the recovery period of AICU was related to factors such as status of consciousness,old age,and aspiration,etc.and the pathogenic bacteria flora were mainly Gram-negative bacteria.It was reasonable to give patients antibacterial treatment and early targeted nursing management,which were essential.