神经内科老年患者呼吸机相关肺炎调查及危险因素分析

Identification and analysis of risk factors for ventilator-associated pneumonia in elderly patients in neurology department

目的 通过对神经内科重症监护病房(NCU)老年患者呼吸机相关性肺炎(VAP)危险因素的调查分析,探索相关防控策略,降低NCU老年患者VAP的发生率。方法 2020年1月1日-2022年12月31日对安徽医科大学第一附属医院在NCU接受呼吸机通气治疗超过48 h的245例老年(≥65岁)患者进行回顾性调查,了解发生VAP的危险因素及病原体分布情况。结果 245例使用呼吸机患者中,67例发生VAP,感染率为27.34%。多因素logistic回归分析显示,颅内出血(OR=5.790,95%CI:2.190~15.309)、抗生素使用时间≥7d(OR=12.438,95%CI:1.474~104.948)、呼吸机使用时间≥5 d(OR=16.105,95%CI:5.288~49.047)是神经内科老年患者VAP感染的危险因素,差异均有统计学意义(P均<0.05)。67例VAP感染患者的痰标本或支气管肺泡灌洗液分离出21种病原体,共112株病原微生物,以鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌为主,分别占29.46%、17.86%、14.29%。结论 在NCU使用呼吸机的老年患者中,VAP感染受颅内出血、抗生素使用时长、呼吸机使用时长等相关危险因素影响,感染的病原体以革兰阴性菌为主。

Objective To investigate and analyze the risk factors of ventilator-associated pneumonia(VAP) in elderly patients in the neurology intensive care unit(NCU), and explore relevant prevention and control strategies to reduce its incidence. Method A retrospective investigation was conducted on 245 elderly patients (≥65 years old) who received ventilation in NCU for more than 48 hours from January 1, 2020 to December 31, 2022 in the First Affiliated Hospital of Anhui Medicial University, and the risk factors and types of pathogens were analyzed. Results Among the 245 patients who have used ventilators, 67 developed VAP, and the infection rate was 27.34%. Multivariate logistic regression showed that VAP was associated with intracranial hemorrhage(OR=5.790, 95%CI:2.190-15.309), antibiotic use for more than 7 days(OR=12.438, 95%CI: 1.474-104.948) and ventilator use for more than 5 days(OR=16.105, 95%CI: 5.288-49.047),the differences were statistically significant(all P<0.05). A total of 21 pathogens were isolated from sputum samples or bronchoalveolar lavage fluid of 67 VAP infected patients, with 112 pathogenic microorganisms. The main pathogens were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa, accounting for 29.46%, 17.86% and 14.29% respectively. Conclusion VAP was common among elderly patients in NCU;the risk factors include intracranial hemorrhage, duration of antimicrobial treatment and duration of ventilator use, and the infection pathogens were mostly Gram-negative bacteria.