颅脑外伤昏迷患者呼吸机相关性肺炎的病原菌分布及影响因素的Logistic回归分析

Logistic Regression Analysis of Pathogenic Bacteria Distribution and Influencing Factors of Ventilator-associated Pneumonia in Coma Patients with Craniocerebral Trauma

目的研究颅脑外伤昏迷患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原菌分布及影响因素的Logistic回归分析。方法回顾性分析2019年2月—2021年2月佛山市南海区人民医院收治的80例颅脑外伤昏迷患者的病历资料。分析其VAP发生情况、病原菌分布及主要革兰阴性菌对常见抗菌药物耐药情况。将所有受试者根据VAP发生与否分为VAP组(n=34)和无VAP组(n=46),比较两组各项病历资料的差异,并以多因素Logistic回归分析明确颅脑外伤昏迷患者VAP的影响因素。结果80例患者中发生VAP有34例,共检出病原菌42株,其中革兰阴性菌22株,革兰阳性菌18株,真菌2株,革兰阴性菌中以铜绿假单胞菌、肺炎克雷伯菌多见,占比分别为21.43%、19.05%。铜绿假单胞菌对阿米卡星及庆大霉素的耐药性较低,均为11.11%,而肺炎克雷伯菌对常见抗菌药物均有不同程度的耐药,耐药率为25.50%~100.00%不等。经单因素分析可得:年龄、机械通气时长、每日口腔护理频次、开放式吸痰均对颅脑外伤昏迷患者VAP的发生有影响(P<0.05)。多因素Logistic回归分析发现:颅脑外伤昏迷患者VAP的独立危险因素是年龄≥60岁、机械通气时长>5 d、每日口腔护理频次<4次、开放式吸痰(P<0.05)。结论颅脑外伤昏迷患者VAP发生的独立危险因素是年龄,机械通气时长,每日口腔护理频次,开放式吸痰,临床工作中可能通过针对上述影响因素予以干预,继而达到降低VAP发生风险的目的。

Objective To study the distribution of pathogenic bacteria and the influencing factors of ventilator-associated pneumonia(VAP)in coma patients with craniocerebral trauma and the results of Logistic regression analysis.Methods The medical records of 80 cases of cranioce⁃rebral trauma and coma patients admitted to Nanhai District People's Hospital of Foshan City from February 2019 to February 2021 were ret⁃rospectively analyzed.The occurrence of VAP,the distribution of pathogenic bacteria and the resistance of major Gram-negative bacteria to common antibiotics were analyzed.All subjects were divided into VAP group(n=34)and no VAP group(n=46)according to the occurrence of VAP.The differences in the medical records of the two groups were compared.Multivariate Logistic regression analysis was used to clarify the factors affecting VAP in traumatic coma patients.Results VAP occurred in 34 of the 80 patients.A total of 42 pathogenic bacteria were de⁃tected,including 22 gram-negative bacteria,18 gram-positive bacteria,and 2 fungi.Among the gram-negative bacteria,Pseudomonas aerugi⁃nosa,pneumonia Klebsiella was more common,accounting for 21.43%and 19.05%,respectively.The resistance of Pseudomonas aeruginosa to amikacin and gentamicin was low,both were 11.11%.Klebsiella pneumoniae had different degrees of resistance to common antibiotics,and the resistance rate ranged from 25.50%to 100.00%.Univariate analysis showed that age,duration of mechanical ventilation,the frequency of daily oral care,and open suction all had effects on the occurrence of VAP in coma patients with Ttrauma(P<0.05).Multivariate Logistic re⁃gression analysis found that the independent risk factors of VAP in patients with traumatic brain injury in coma included the age≥60 years old,mechanical ventilation duration>5 d,daily oral care frequency<4 times and open type sputum suction(P<0.05).Conclusion The indepen⁃dent risk factors for VAP in traumatic coma patients were age,the duration of mechanical ventilation,the frequency of daily oral care,and open sputum aspiration.In clinical work,it is possible to intervene the above factors to reduce the risk of VAP.