呼吸机相关性肺部感染病原菌检测结果及相关危险因素分析

The detection results of pathogenic bacteria in ventilator-associated pulmonary infection and related risk factors

目的探索呼吸机相关性肺部感染病原菌检测结果及相关危险因素分析。方法选取2015年11月至2018年11月于ICU行机械通气的216例患者作为研究对象,根据检查结果结果将其分为呼吸机相关性肺炎组(VAP组,n=77)和非呼吸机相关性肺炎组(非VAP组,n=139)。检测并分析VAP组患者肺部感染病原菌情况;先对2组患者性别、年龄、吸烟史、原发病、APACHEⅡ评分、低蛋白血症、意识障碍、住院时间、机械通气时间、留置胃管、是否手术、糖皮质激素使用、抗菌药物联合应用、抑酸剂使用进行单因素分析,而后以呼吸机相关性肺部感染是否发生为因变量,对2组差异有统计学意义的单因素进行多因素Logistic回归分析。结果77例VAP患者中检出132株病原菌,其中30株为革兰阳性菌,81株为革兰阴性菌,21株为真菌,分别占22.73%、61.36%、15.91%,前三类病原菌依次为铜绿假单胞菌属、金黄色葡萄球菌及克雷伯杆菌属;单因素结果显示2组患者在年龄、原发病、APACHEⅡ评分、低蛋白血症、意识障碍、住院时间、机械通气时间、糖皮质激素使用、抗菌药物联合应用、抑酸剂使用十个方面有明显差异(P<0.05);进一步对差异有统计学意义的单因素进行多因素Logistic回归分析,结果显示年龄(OR=2.807,95%CI 1.327~5.934)、APACHEⅡ评分(OR=2.296,95%CI 1.448~3.639)、意识障碍(OR=2.273,95%CI 1.305~3.958),住院时间(OR=2.499,95%CI 1.115~5.604)、机械通气时间(OR=2.309,95%CI 1.295~4.117)、糖皮质激素(OR=3.232,95%CI 1.699~6.146)、抗菌药物联合应用(OR=3.518,95%CI 1.854~6.679)为呼吸机相关性肺部感染发生的独立危险因素。结论呼吸机相关性肺部感染病原菌以革兰阴性菌为主,年龄、APACHEⅡ评分、意识障碍、住院时间、机械通气时间、糖皮质激素、抗菌药物联合应用为呼吸机相关性肺部感染发生的独立危险因素,通过监测上述七个指标,可为呼吸机相关性肺部感染发生提供预测价值。

Objective To investigate the detection results of pathogenic bacteria in ventilator-associated pulmonary infection and related risk factors.Methods A total of 216 patients who underwent mechanical ventilation in ICU of our hospital from November 2015 to November 2018 were enrolled in the study.According to the results of the examination,these patients were divided into ventilator-associated pneumonia group(VAP group,n=77)and non-ventilator-associated pneumonia group(non-VAP group,n=139).The pathogenic bacteria of pulmonary infection in VAP group were detected and analyzed.Firstly,the patient’s sex and age,smoking history,primary disease,APACHEⅡscore,hypoproteinemia,consciousness disorder,hospitalization time,mechanical ventilation time,gastric tube indwelling,operation,glucocorticoid use,antimicrobial drug combination,acid inhibitor use in both groups were analyzed by single factor analysis,then taking ventilator-associated pulmonary infection as dependent variable,multivariate logistic regression analysis was used to analyze the results with statistical significance made by single factor analysis.Results A total of 132 strains of pathogenic bacteria were detected in 77 patients with VAP,of which,30 strains were Gram-positive bacteria,81 strains were Gram-negative bacteria and 21 strains were fungi,accounting for 22.73%,61.36%,15.91%,respectively.The first three pathogenic bacteria were pseudomonas aeruginosa,staphylococcus aureus and klebsiella in turn.Univariate results showed that there were significant differences in the patient’s age,primary disease,APACHEⅡscore,hypoproteinemia,consciousness disorders,hospitalization time,mechanical ventilation time,glucocorticoid use,combined use of antibiotics and antacid use between the two groups(P<0.05).Further logistic regression analysis for the single factor analysis results with statistical significance showed that patient’s age,APACHEⅡscore,consciousness disorders,hospitalization time,mechanical ventilation time,glucocorticoid,combined use of antibiotics were independent risk factors for ventilator-related pulmonary infection.Conclusion Gram-negative bacteria are the main pathogens of ventilator-associated pulmonary infections,and patient’s age,APACHEⅡscore,consciousness disorders,hospitalization time,mechanical ventilation time,glucocorticoid and antibiotics are independent risk factors for the occurrence of ventilator-associated pulmonary infection.To monitor the above seven indexes has predictive value for the occurrence of ventilator-associated pulmonary infection.