ICU感染性休克并发呼吸机相关性肺炎的影响因素及其发生的预测指标探讨

Influencing factors of ICU septic shock complicated with ventilatorassociated pneumonia and exploration of its predictive indicators

目的探讨重症监护室(ICU)感染性休克并发呼吸机相关性肺炎(VAP)的影响因素及其发生的预测指标。方法选取邢台市第三医院2019年1月—2021年5月ICU感染性休克患者174例作为研究对象,根据是否并发VAP分为观察组(发生VAP,68例)与对照组(未发生VAP,106例)。收集两组临床资料,分析感染性休克并发VAP的影响因素,并构建列线图预测模型。结果Logistic回归分析显示,机械通气时间、抗菌药物使用种类、合并糖尿病、肺部基础疾病、急性生理与慢性健康(APACHEⅡ)评分、血清降钙素原(PCT)、C反应蛋白(CRP)是感染性休克并发VAP的独立危险因素,血清ALB是感染性休克并发VAP的独立保护因素(P<0.05);列线图显示,机械通气时间、抗菌药物使用种类、合并糖尿病、肺部基础疾病、APACHEⅡ评分、人血白蛋白(ALB)、PCT、CRP均对感染性休克并发VAP具有一定预测价值,且根据上述预测指标构建感染性休克并发VAP的列线图预测模型,一致性指数为0.982,预测概率与实际概率的吻合度较高;受试者工作特征(ROC)曲线分析,该列线图模型预测感染性休克并发VAP的曲线下面积(AUC)为0.982,95%CI为0.967~0.997,敏感度为98.11%,特异度为88.24%。结论机械通气时间、抗菌药物使用种类、合并糖尿病、肺部基础疾病、APACHEⅡ评分、血清PCT、CRP、ALB是感染性休克并发VAP的独立影响因素,且作为预测指标共同构建的列线图模型具有可靠预测价值。

Objective To explore the influencing factors of septic shock in intensive care unit(ICU)complicated with ventilator-associated pneumonia(VAP)and its predictive indicators.Methods A total of 174 patients with septic shock in the ICU from January 2019 to May 2021 in e third hospital of xingtai were selected as the research objects.According to whether they were complicated with VAP,they were divided into observation group(VAP),68 cases and control group(no VAP,106 cases).Clinical data of the two groups were collected,the influencing factors of septic shock complicated by VAP were analyzed,and a nomogram prediction model was constructed.Results Logistic regression analysis showed that duration of mechanical ventilation,type of antimicrobial drug use,combined diabetes mellitus,underlying pulmonary disease,APACHEⅡ score,serum PCT,and CRP were independent risk factors for VAP complicated by infectious shock,and serum ALB was an independent protective factor for VAP complicated by infectious shock(P<0.05).The column line graph showed that duration of mechanical ventilation,type of antimicrobial drug use,combined diabetes,underlying lung disease,APACHEⅡ score,serum ALB,PCT,and CRP all had some predictive value for VAP complicated by infectious shock,and the column line graph prediction model for VAP complicated by infectious shock was constructed based on the above predictors,and the consistency index was 0.982,and the predicted probability was in good agreement with the actual probability;ROC curve analysis,the column the AUC of the line graph model for predicting infectious shock complicated by VAP was 0.982,with 95%CI of 0.967~0.997,sensitivity of 98.11%and specificity of 88.24%.Conclusion The duration of mechanical ventilation,the types of antibacterial drugs used,diabetes,underlying lung diseases,APACHEⅡ score,serum PCT,CRP,and ALB are independent influencing factors of septic shock complicated by VAP,and the nomogram model constructed together as predictive indicators has reliably predict value.