综合性ICU中呼吸机相关性肺炎危险因素多元逐步Logistic回归分析

Multivarite stepwise Logistic regression analysis of risk factors for ventilator-associated pneumonia in comprehensive ICU

目的 :调查综合性 ICU中呼吸机相关性肺炎 (VAP)的发病率、病死率和独立危险因素。 方法 :回顾 1999年 1月至2 0 0 0年 12月本科综合性 ICU中收治的 97名机械通气超过 4 8h患者的临床资料和微生物学资料 ,并将患者分为 VAP和非VAP组 ,先以单因素分析筛选出有统计学意义的危险因素 ,再通过后退法多元逐步 L ogistic回归分析确定 VAP的独立危险因素。结果 :本组患者 VAP的发病率为 5 4 .6 4 %、15 .6 0例 / 10 0 0机械通气日 ,病死率为 4 7.4 2 %。发生 VAP者从人工气道建立到诊断的间期为 (6 .9± 4 .3) d。单因素分析提示留置胃管、激素、抑酸剂、第 2代头孢、第 3代头孢和 (或 )亚胺培南、非感染性肺疾患、肺外感染是 VAP的危险因素 ,回归分析提示留置胃管 ,抑酸剂、激素、第 3代头孢和 (或 )亚胺培南、肺外感染的相对危险度及其 95 %可信区间分别为 :15 .395 (2 .15 7～ 10 9.86 5 )、4 .4 2 1(0 .86 0～ 2 2 .72 2 )、15 .5 2 1(2 .0 4 6～ 117.731)、14 .5 38(2 .771～ 76 .2 88)、19.379(2 .4 13～ 15 5 .6 0 1)。 结论 :留置胃管、激素、抑酸剂、第 3代头孢和 (或 )亚胺培南、肺外感染是

Objective:To determine the morbidity, crude mortality and independent risk factors of ventilator associated pneumonia (VAP) in comprehensive ICU. Methods:The clinical data and micro organism data of all the 97 mechanical ventilation (>48 h) patients admitted to our comprehensive ICU from 1999 Jan to 2000 Dec were retrospecitvely analysed. Several statistically significant risk factors were screened out with univarite analysis, then independent risk factors were determined with multivarite stepwise logistic regression analysis. Results:The morbidity of VAP was 54.64% and 15.60 cases per 1 000 ventilation day. The crude mortality was 47.42%. Interval between the establishment of artificial airway and diagnosis of VAP was (6.9±4.3) d. Univarite analysis showed that indwelling nasogastric tube, corticosteroid, acid inhibitor, second and third generation cephalosporin/imipenem, non infection lung disease, and extrapulmonary infection were statistically significant risk factors of VAP, while multivarite stepwise logistic regression analysis showed that the relative risk and 95% confidencial interval of indwelling nasogastric tube, acid inhibitor, corticosteroid, third generation cephalosporin/imipenem, extrapulmonary infection were: 15.395(2.157 109.865), 4.421(0.860 22.722), 15.521(2.046 117.731), 14.538 (2.771 76.288), 19.379(2.413 155.601) respectively. Conclusion:Indwelling nasogastric tube, corticosteroid, acid inhabitor, third generation cephalosporin/imipenem, extrapulmonary infection are independent risk factors of VAP.