呼吸机相关性肺炎预后的影响因素分析

Analysis of factors influencing the prognosis of ventilator-associated pneumonia

目的分析重症医学科呼吸机相关性肺炎(VAP)患者预后的影响因素。方法回顾性分析重症医学科中初次诊断为呼吸机相关性肺炎的107例患者的资料,根据初次确诊呼吸机相关性肺炎后28 d内存活情况分为死亡组(33例)及存活组(74例)。比较两组疾病情况和治疗情况,并进行多因素Logistic回归分析。结果死亡组患者的年龄(71.67±10.20)岁、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(20.79±3.34)分、序贯器官衰竭估计评分(SOFA评分)(7.61±1.82)分高于存活组的(63.61±11.73)岁、(18.19±4.42)分、(6.03±2.01)分,肠外营养占比9.09%、气管切开占比36.36%低于存活组的29.73%、72.97%,有统计学差异(P<0.05);两组患者的激素应用、呼气末正压通气(PEEP)>5 cm H2O(1 cm H2O=0.098 kPa)、不恰当经验性抗生素、中心静脉导管、细菌学情况及插管时间比较无统计学差异(P>0.05)。多因素Logistic回归分析显示,年龄高[95%CI=(1.005,1.129),P=0.033<0.05]、SOFA评分高[95%CI=(1.375,3.327),P=0.001<0.05]是呼吸机相关性肺炎患者死亡的独立危险因素,气管切开[95%CI=(0.029,0.400),P=0.001<0.05]、肠外营养[95%CI=(0.002,0.160),P=0.000<0.05]是呼吸机相关性肺炎患者死亡的保护因素;APACHEⅡ评分对呼吸机相关性肺炎患者死亡无显著影响(P>0.05)。结论气管切开以及肠外营养对呼吸机相关性肺炎预后有积极影响,高龄及高SOFA评分会增加患者的死亡率。

Objective To analyze the factors influencing the prognosis of ventilator-associated pneumonia(VAP).Methods 107 patients who were first diagnosed with VAP in intensive care unit were retrospectively analyzed.They were divided into death group(33 cases)and survival group(74 cases)according to the survival status within 28 d after the first diagnosis of ventilator-associated pneumonia.The disease status and treatment status of the two groups were compared,and multivariate Logistic regression analysis was performed.Results In the death group,the age was(71.67±10.20)years old,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score was(20.79±3.34)points,and the Sequential Organ Failure Assessment(SOFA)score was(7.61±1.82)points,which were higher than(63.61±11.73)years old,(18.19±4.42)points,and(6.03±2.01)points in the survival group;the percentage of parenteral nutrition was 9.09%and the rate of tracheotomy was 36.36%,which were lower than 29.73%and 72.97%in the survival group;there was a statistical difference(P<0.05).There was no statistically significant difference in hormone application,positive end-expiratory pressure ventilation(PEEP)>5 cm H2O(1 cm H2O=0.098 kPa),inappropriate empiric antibiotics,central venous catheter,bacteriological profile and intubation time between the two groups(P>0.05).Multivariate Logistic regression analysis showed that advanced age[95%CI=(1.005,1.129);P=0.033<0.05],high SOFA score[95%CI=(1.375,3.327);P=0.001<0.05]were independent risk factors for death of patients with ventilator-associated pneumonia,tracheotomy[95%CI=(0.029,0.400);P=0.001<0.05],and parenteral nutrition[95%CI=(0.002,0.160);P=0.000<0.05]were the protective factors for death of patients with ventilator-associated pneumonia,and the APACHEⅡscore did not have a significant effect on death of patients with ventilator-associated pneumonia(P>0.05).Conclusion Tracheotomy and parenteral nutrition have a positive effect on the prognosis of ventilator-associated pneumonia,then advanced age and high SOFA score increase the mortality rate of patients.