机械通气重症肺炎患儿呼吸机相关性感染危险因素调查及护理对策

Investigation on risk factors of ventilator-related infection in children with severe ventilator-associated pneumonia and nursing countermeasures

目的:分析机械通气重症肺炎患儿呼吸机相关性感染(VAP)的危险因素,探讨其护理对策。方法:选取2017年10月—2019年9月行机械通气治疗的260例重症肺炎患儿为研究对象,统计VAP发生率,按是否发生VAP将患儿分为VAP组、非VAP组,分析患儿发生VAP相关因素,多因素Logistic回归分析影响VAP发生的危险因素,并提出相应护理对策。结果:260例患儿中22例出现VAP,发生率为8.46%;两组患儿出生体重、插管方式、通气时间、插管次数、早期使用抗生素、头部位置相比差异有统计学意义(P<0.05);插管方式、通气时间、插管次数、早期用抗生素、头部位置是影响患儿VAP发生的相关因素(P<0.05)。结论:机械通气重症肺炎患儿VAP发生率较高,且受多种因素影响,临床应针对其危险因素,优先选取经口气管插管、减少通气时间及插管次数,合理使用抗生素,抬高头部治疗,以降低VAP的发生率。

Objective:To analyze the risk factors of ventilator-related infection in children with severe ventilator-associated pneumonia(VAP),and to explore nursing countermeasures.Methods:A total of 260 children with severe pneumonia who underwent mechanical ventilation in our hospital from October 2017 to September 2019 were enrolled as the research subjects.The incidence of VAP was calculated,and the children were divided into the VAP group and the non-VAP group according to whether or not VAP occurred.The differences were analyzed in related factors between the two groups of children,the multi-factor Logistic regression was used to analyze the risk factors affecting the occurrence of VAP,and propose corresponding nursing strategies.Results:VAP occurred in 22 of the 260 children,with an incidence of 8.46%;there were statistically significant differences(P<0.05)between the two groups in terms of birth weight,intubation method,ventilation time,number of intubations,early antibiotic use,and head position.Intubation methods,ventilation time,number of intubations,early antibiotics use,and head position were related factors that affect the occurrence of VAP in children(P<0.05).Conclusions:The incidence of VAP was higher in children with severe pneumonia on mechanical ventilation,and it was affected by many factors.According to the risk factors of VAP,in the clinical,oral endotracheal intubation should be selected first,ventilation time and intubation frequency should be reduced,antibiotics should be used rationally,and keep the head of the patient′s bed raised to reduce the occurrence of VAP.