辅助通气治疗的RDS早产儿发生VAP的危险因素

Risk factors of VAP in preterm infants with RDS treated with assisted ventilation

目的:探究辅助通气治疗的呼吸窘迫综合征(RDS)早产儿发生呼吸机相关性肺炎(VAP)的危险因素。方法:选择2020年5月至2022年5月于泉州市第一医院接受辅助通气治疗的RDS早产儿100例为观察目标,统计辅助通气期间VAP发生率,按照有无VAP发生分成VAP组和无VAP组,通过单因素与多因素Logistic回归分析法对RDS早产儿辅助通气期间VAP发生危险因素予以分析。结果:100例RDS早产儿在辅助通气治疗期间发生VAP者34例、未发生VAP者66例,VAP发生率是34%(34/100);单因素分析显示,VAP组早产儿的有创机械通气治疗时间、拔管后无创通气治疗时间、新生儿窒息率、新生儿抢救率、重复插管上机治疗次数均高于无VAP组,差异有统计学意义(P<0.05);多元Logistic回归分析显示,有创机械通气治疗时间、拔管后无创通气治疗时间、新生儿窒息、新生儿抢救、重复插管上机治疗次数>3次为RDS早产儿辅助通气治疗期间VAP发生的独立危险因素(P<0.05)。结论:RDS早产儿辅助通气期间受机械通气治疗时间、新生儿窒息及重复插管上机治疗次数等因素影响,存在较高的VAP发生可能性。

Objective:To explore the risk factors of ventilator-associated pneumonia(VAP)in premature infants with respiratory distress syndrome(RDS)undergoing assisted ventilation.Methods:A total of 100 premature infants with RDS who received assisted ventilation in Quanzhou First Hospital from May 2020 to May 2022 were selected as observation targets.The incidence of VAP during assisted ventilation was counted.According to the occurrence of VAP,they were divided into VAP group and non-VAP group.The risk factors of VAP during assisted ventilation in premature infants with RDS were analyzed by univariate and multivariate logistic regression analysis.Results:There were 34 premature infants of VAP and 66 premature infants of non-VAP in 100 premature infants with RDS during assisted ventilation,and the incidence of VAP was 34%(34/100).Univariate analysis showed that the time of invasive mechanical ventilation treatment,the time of non-invasive ventilation treatment after extubation,the rate of neonatal asphyxia,the rate of neonatal rescue,and the number of repeated intubations in the VAP group were higher than those in the non-VAP group,the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the time of invasive mechanical ventilation treatment,the time of non-invasive ventilation treatment after extubation,neonatal asphyxia,neonatal rescue,and the number of repeated intubations>3 times were independent risk factors for VAP during assisted ventilation treatment in preterm infants with RDS(P<0.05).Conclusion:There is a high possibility of VAP in premature infants with RDS during assisted ventilation due to factors such as mechanical ventilation treatment time,neonatal asphyxia and repeated intubation.