ICU机械通气并发呼吸机相关性肺炎患者预后不良的影响因素

Influencing factors of poor prognosis in ICU patients with mechanical ventilation combined with ventilator-associated pneumonia

目的:探讨重症监护室(ICU)机械通气并发呼吸机相关性肺炎(VAP)患者预后不良的影响因素。方法:选取2020年10月至2022年10月昌江黎族自治县人民医院收治的96例ICU机械通气并发VAP患者进行前瞻性研究,进行28 d院内随访和电话随访,将死亡患者纳入预后不良组,其余患者纳入预后良好组,比较两组临床资料,分析ICU机械通气并发VAP患者预后不良的影响因素。结果:96例ICU机械通气并发VAP患者中,16例预后不良,80例预后良好,预后不良发生率为16.67%(16/96);两组性别、合并高脂血症、合并高血压、合并糖尿病、病原菌类型、体质量指数、白细胞计数占比比较,差异均无统计学意义(P>0.05);两组年龄、机械通气类型、住院时间、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)占比比较,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,PCT>2.5 ng/mL、hs-CRP>40 mg/L均为影响ICU机械通气并发VAP患者预后不良的危险因素(P<0.05)。结论:PCT>2.5 ng/mL、hs-CRP>40 mg/L均为影响ICU机械通气并发VAP患者预后不良的危险因素。

Objective:To explore influencing factors of poor prognosis in patients with mechanical ventilation combined with ventilator-associated pneumonia(VAP)in the intensive care unit(ICU).Methods:From October 2020 to October 2022,96 ICU patients with mechanical ventilation combined with VAP admitted to the Changjiang Li Autonomous County People’s Hospital were selected for the prospective study,and 28 days of hospital and telephone follow-up were conducted.The dead patients were included in poor prognosis group,and the other patients were included in good prognosis group.The clinical data of the two groups were compared,and the influencing factors of poor prognosis in the ICU patients with mechanical ventilation combined with VAP were analyzed.Results:Among the ICU 96 patients with mechanical ventilation combined with VAP,16 had poor prognosis,80 had good prognosis,and the incidence of poor prognosis was 16.67%(16/96).There were no significant differences between the two groups in gender,hyperlipidemia,hypertension,diabetes,pathogen type,body mass index and white blood cell count(P>0.05).There were significant differences in age,type of mechanical ventilation,hospitalization time,and proportions of Calcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)between the two groups(P<0.05).The logistic regression analysis showed that PCT>2.5 ng/mL and hs-CRP>40 mg/L were both risk factors for the poor prognosis in the ICU patients with mechanical ventilation combined with VAP(P<0.05).Conclusions:PCT>2.5 ng/mL and hs-CRP>40 mg/L are the risk factors for the poor prognosis in the ICU patients with mechanical ventilation combined with VAP.