Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.

Risk assessment of ischemic stroke associated pneumonia

BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome

AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.

Subglottic Secretion Drainage for Preventing Ventilator Associated Pneumonia: A Meta-analysis

Objective： Ventilator associated pneumonia （VAP） has been shown to be associated with significant morbidity and mortality（ Chastre and Fagon, 2002; klompas, 2007） among mechanically venti- lated patients in the intensive care unit （ICU）, with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage （SSD） on the incidence of ventilated associated pneumonia in adult ICU patients. Methods： Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases （December 30, 2010）. Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results： Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk （RR） =0.52, 95% confidence interval （C/）： 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 （95% CI, 0.84-1.19） and for hospital mortality was 0.95 （95% CI, 0. 80-1.13）. Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days （95% CI, -2.94 to -0.11） and on the ICU length of stay （LOS） was -0.81days （95% CI, -2.33 to -0.7）. Conclusions： In this meta-analysis, when an endotracheal tube （ETT） with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation （MV） and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

Background: Hyperglycemia is always seen amongst acute intra-cerebral hemorrhage (ICH) and usually has been reported in literature and studied in relation to mortality and poor recovery. However, literature specific to stroke-associated pneumonia (SAP) on this topic is very small. Further, how to differentiate the predictive value of hyperglycemia with and without abnormal HbA1C in such patients is still a matter of debate and no universal consensus. We evaluated hyperglycemia as a marker for SAP in patients with ICH to assess its usefulness as a potential predictor. Materials and methods: Clinical characteristics for a sample of 551 patients with acute ICH were collected from the Beijing Tiantan Hospital of Capital Medical University, Beijing, China. Possible associated risk factors of SAP were reviewed. Hyperglycemia and HbA1C on admission were the main hypothetic predictor, SAP occurring within the first 7 days is the primary outcome. Results: The cohort study includes 551 hospitalized patients. The prevalence of hyperglycemia was 52.5% and SAP occurred in 147 (26.7%). The incidence of SAP was higher in the group with hyperglycemia than those without hyperglycemia (37.7% versus 14.5%, p 6.5) (OR, 1.57;95%CI, 0.81 - 3.23) had not been shown to be associated with SAP. Conclusions: In this hospital-based cohort of patients presenting with acute intra-hemorrhage, hyperglycemia on admission was associated significantly with SAP. The association was stronger for hyperglycemia with normal HgbA1C than for hyperglycemia with high HgbA1C. Hyperglycemia with normal HgbA1C might be a more sensitive predictor of early acute complication, such as SAP.

The Diagnostic and Prognostic Value of Serum Procalcitonin among Ventilator Associated Pneumonia Patients

Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.

Ventilator Associated Pneumonia in an Intensive Care Unit

The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.

Pseudomonas aeruginosa ventilator associated pneumonia: improved outcomes with earlier follow-up

It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.

Natural History, Outcomes and Antibiotic Treatment for Ventilator-Associated Tracheobronchitis in Critical Ill Patients

We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.

The Association of Pneumonia with Clinical Outcome in Patients with Inhalation Injury

Introduction: Inhalation injury is a particularly lethal form of thermal burn injury, and is associated with increased morbidity and mortality. Pneumonia is a common complication of inhalation injury, due to the increased susceptibility of lungs that have been stripped of their biologic defense mechanisms, as well as the general susceptibility of the burn population to infections. While older series suggest that pneumonia is associated with worse mortality and morbidity, recent reports suggest that this may not be the case in all populations. Methods: We attempted to clarify the impact of pneumonia in terms of mortality, length of mechanical ventilation, need for tracheostomy, and discharge disposition, in patients admitted with inhalation injury by performing a retrospective review of patients admitted to a regional burn center 2002-2009. Burn registry and electronic chart review were used to obtain demographic, clinical and outcome data. Univariate and multivariate analysis was used to compare outcomes in patients who developed pneumonia versus those who did not. Results: The study cohort comprised 166 patients, of whom 21 (13%) were diagnosed with pneumonia. Development of pneumonia was not predicted by age, surface area burned or other complications such as acute respiratory distress syndrome. Surprisingly, pneumonia was associated with reduced inpatient mortality (p = 0.006). However, patients who developed pneumonia were also more likely to have prolonged ventilator dependence (19 vs 5 days,

基于循证证据的脑卒中相关性肺炎预防措施在ICU急性缺血性脑卒中病人中的应用效果

目的:总结预防脑卒中相关性肺炎的循证证据并评价其临床应用效果。方法:选择2022年1月—12月安徽省某三级甲等医院神经内科ICU收治的59例急性缺血性脑卒中病人为研究对象,将2022年1月—5月收治的29例重症脑卒中病人为基线组,2022年8月—12月收治的30例重症脑卒中病人为循证实践组。以基于证据的持续质量改进模型作为理论框架,通过证据获取、现状审查、证据引入和效果评价4个阶段将脑卒中相关性肺炎预防的证据转化为临床实践。比较循证实践前后两组脑卒中病人脑卒中相关性肺炎的发生率、炎症指标和临床结局指标,以及循证实践前后医护人员预防脑卒中相关性肺炎证据认知水平变化。结果:最终纳入18条证据,并转化为10条审查指标。循证实践后,病人脑卒中相关性肺炎发生率及白细胞计数、C反应蛋白、ICU住院时间均明显降低(P<0.05)。循证实践后医护人员预防脑卒中相关性肺炎知识审查指标执行率均提高(P<0.05)。结论:以证据为基础的循证护理实践能够提高医护人员循证知识知晓率及对最佳证据的依从性,改善脑卒中病人的炎症指标,缩短ICU住院时间,降低脑卒中病人脑卒中相关性肺炎的发生率。

针对性气道护理对重症监护室患者舒适度与呼吸机相关性肺炎的影响

目的探讨针对性气道护理模式在重症监护室(ICU)患者中的应用效果。方法选择2021年1月—2022年12月医院120例ICU患者,按组间基线资料可比的原则将其分为对照组和观察组,每组60例。对照组予以常规护理,观察组采用针对性气道护理。观察两组患者护理干预前、护理干预5 d后的呼吸状况及舒适度,比较其康复进程、导管堵塞情况及呼吸机相关性肺炎(VAP)发生情况。结果观察组患者护理干预5 d后的PaO_(2)水平高于对照组,组间比较差异有统计学意义(P<0.05)。PaCO_(2)水平低于对照组,组间比较差异有统计学意义(P<0.05)。观察组患者护理干预5 d后的Kolcaba舒适状况量表(GCQ)评分高于对照组,差异有统计学意义(P<0.05)。观察组患者机械通气时间及ICU治疗时间分别为6.50±1.08 d和7.84±1.50 d,短于对照组的7.22±1.36 d和8.68±1.74 d,差异有统计学意义(P<0.05);观察组患者机械通气期间的导管堵塞程度较对照组轻,且VAP发生率低于对照组,差异均有统计学意义(P<0.05)。结论针对性气道护理模式可改善ICU患者呼吸状况及舒适度,缩短康复进程,并可减轻患者机械通气治疗期间导管堵塞程度,降低VAP发生率。

白念珠菌气道定植对铜绿假单胞菌所致呼吸机相关性肺炎的影响

目的探讨白念珠菌气道定植对多重耐药铜绿假单胞菌所致呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者病死率、抗菌药物疗程、免疫状态及炎症状态的影响。方法本前瞻性多中心队列研究以2018年6月至2023年6月收治于6所三级甲等综合教学医院重症医学科的多重耐药铜绿假单胞菌所致VAP患者为研究对象。根据患者呼吸道是否存在白念珠菌定植分为定植组及非定植组。比较两组患者30 d全因死亡率、抗菌药物敏感性及疗程、诊断VAP后第1、3、5、7天免疫指标及炎症指标变化。结果5年研究期间共纳入多重耐药铜绿假单胞菌导致VAP患者232例,其中白念珠菌定植组105例,非定植组127例。非定植组患者检出的铜绿假单胞菌对于氨基糖苷类、头孢菌素类及碳青霉烯类抗菌药物的敏感性均高于定植组(P<0.05),但两组患者对于16种抗菌药物的敏感性均低于中国细菌耐药监测网(China antimicrobial surveillance network,CHINET)2022年水平(P<0.05)。研究发现非定植组患者白介素-17A、(1,3)-β-D葡聚糖在各时间节点均低于定植组,且其他炎性指标更容易恢复至正常范围(P<0.05),同时非定植组患者的T及Th淋巴细胞绝对值可以在第7天更快地恢复至正常水平(P<0.05)。两组患者30 d全因死亡率差异无统计学意义(25.7%vs 22.8%,P=0.61),但非定植组抗菌药物的疗程明显短于定植组[(11.3±3.1)d vs(14.2±4.7)d,P<0.01],且存在重症医学科住院时间缩短的趋势。结论气道白念珠菌定植不影响多重耐药铜绿假单胞菌所致VAP患者的30 d全因死亡率,但会延长炎症反应及抗菌药物使用时间并导致免疫功能延迟恢复。

肺超声指导下的体位管理在新生儿呼吸机相关性肺炎中的临床应用

目的探索肺超声指导下的体位管理在新生儿呼吸机相关性肺炎(VAP)中的临床效果。方法选取新生儿科收治的胎龄>32周且诊断为VAP的患儿50例为研究对象,采用随机数字表法分为肺超声指导下的体位管理组(观察组)和常规体位管理组(对照组)。比较两组患儿肺超声征象、实施方案后血气分析、氧合指数、肺超声评分、呼吸机使用情况、住院时间、并发症等情况。结果两组背部超声评分均较胸前或侧胸评分高,干预7 d后,观察组的胸前、侧胸及背部超声评分均较对照组降低,差异均有统计学意义(P<0.05);其中背部超声评分较胸前及侧胸评分高且变化明显,差异有统计学意义(P<0.05)。观察组在干预3、7 d的总超声评分均较对照组降低,差异有统计学意义(P<0.05);其中观察组干预7 d后的总超声评分较干预前(首次)显著降低(P<0.05)。观察组干预后第7天的氧合指数较干预前明显降低,且较对照组低,差异有统计学意义(P<0.05)。观察组与对照组在呼吸机使用时间差异有统计学意义(P<0.05)。结论肺超声可作为监测手段指导的新生儿VAP的体位管理,有助于缩短新生儿VAP患儿的呼吸机使用时间,值得临床推广应用。

基于临床资料和血清指标构建脑出血合并卒中相关性肺炎的预测模型构建及验证

目的研究脑出血(ICH)患者合并卒中相关性肺炎(SAP)的危险因素,并构建Nomogram预测模型,预测ICH患者合并SAP的风险。方法选取2017年12月至2022年6月321例ICH患者合并SAP的情况进行调查,根据是否发生SAP分为SAP组和对照组,调查2组临床资料及中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)水平,以是否合并SAP为因变量,采用Lasso回归和Logistic回归筛选ICH患者合并SAP的独立危险因素,使用R语言构建Nomogram预测模型,并对构建的模型进行评估。结果321例ICH患者中57例发生SAP,Lasso回归和Logistic回归筛选出:年龄、肺部基础疾病、糖尿病、吞咽困难、NLR、PLR和气管插管是ICH患者合并SAP的危险因素(P<0.05),基于上述因素构建Nomogram预测模型,对于构建Nomogram预测模型进行评估显示,C-index值为0.867,95%CL(0.856~0.945),模型区分度良好:AUC为0.815,95%CL(0.854~0.945),模型准确性良好,校准曲线证明模型预测能力尚可,临床决策曲线显示:当MCI概率阈值>11%以及<85%使用此模型可以获得较高净获益。结论本研究构建的ICH患者合并SAP的Nomogram预测模型,具有良好区分度和精准度。

床旁超声探查气管插管患者声门下分泌物及其滞留的危险因素分析

目的应用床旁超声探查气管插管患者声门下分泌物,并分析其滞留的危险因素。方法选取2023年1月-6月在综合ICU接受治疗的200例气管插管患者,通过床旁超声技术判断是否发生气管插管声门下分泌物滞留,分为滞留组与无滞留组。采用单因素分析气管插管患者声门下分泌物滞留的影响因素,并使用二元Logistic回归分析气管插管患者声门下分泌物滞留的高危因素。结果200例气管插管患者中声门下分泌物滞留的患者106例,占比53%。单因素分析显示,年龄、插管天数、插管材质、声门下吸引气管插管比例、留置胃管、8 mm气管插管、非全麻手术患者疾病种类比例是声门下分泌物滞留的影响因素。二元Logistic回归分析显示,年龄(OR=0.699)和留置胃管(OR=2.499)是声门下分泌物滞留的独立危险因素(P<0.05)。结论床旁超声在气管插管患者声门下分泌物探查中具有一定的应用价值,年龄和留置胃管是声门下分泌物滞留的独立危险因素,为临床护理人员加强气道管理提供了理论参考。

呼吸机相关性肺炎风险预测模型的研究进展

呼吸机相关性肺炎(VAP)是机械通气患者常见的并发症,不仅增加患者医疗费用,而且威胁其生命安全。风险预测模型能够预测某种结局事件的概率,有助于识别高风险人群。目前,国内外许多研究基于传统Logistic回归方法或机器学习法构建VAP的预测模型,并将预测模型转换为列线图或风险评分。VAP风险预测模型能够有效帮助临床医护人员快速、准确地筛查高风险人群,进而及时有效地针对高风险人群采取相应的预防措施,从而降低VAP发生率。

治疗病毒性肺炎的古方配伍特征分析研究

目的利用关联规则算法,探索治疗病毒性肺炎古方中的单味药频次及药物之间配伍特征。方法利用中国中医科学院中医药信息研究所“中医古方数据库”,检索治疗病毒性肺炎相关古方,得到985首方剂,去除与本次检索目的无关方剂,最终纳入749首方剂进行分析。采用Excel 2016建立数据表,并对单味药进行统计、药物配伍、关联规则分析及聚类分析。筛选时间为建库至2023年10月。结果收集方剂中共涉及290味药,筛选出在治疗病毒性肺炎古方中出现频次≥50次的药物,共有43味药,对其中高频单味药进行统计得出:⑴从药性角度分析,温性药18味、出现1773次,寒性药16味、出现1226次,各占药性频次总数的43.33%和29.96%;⑵从药味角度分析,辛味药18味、出现2268次,苦味药22味、出现2013次,甘味药17味、出现1681次,各占药味频次总数的35.55%、31.55%和26.35%;⑶从归经角度分析,归肺经药26味、出现2501次,归脾经药23味、出现2447次,归胃经药18味、出现1587次,归心经药14味、出现1324次,各占归经频次总数的21.45%、20.99%、13.61%和11.36%;⑷从功效角度分析,解表药12味、出现2501次,补虚药7味、出现827次,清热药9味、出现662次,各占功效频次总数的27.59%、20.21%和16.18%。治疗病毒性肺炎古方中药物关联规则结果显示,重要性高的3个药物组合分别为“苦杏仁、石膏、麻黄”“金银花、甘草、连翘”“草果、藿香、厚朴”。结论治疗病毒性肺炎古方中,药物多偏于温辛、寒苦、寒甘等,入肺、脾、胃经,以清热解毒、宣肺透邪为基本治则。

老年慢性阻塞性肺疾病急性加重病人呼吸机相关性肺炎诺莫图模型的预测价值

目的筛选老年慢性阻塞性肺疾病(COPD)急性加重病人发生呼吸机相关性肺炎(VAP)的危险因子,验证以此构建的诺莫图预测模型的价值。方法以2016年12月至2021年11月聊城市第二人民医院收治的374例老年COPD病人为研究对象,按6∶4的比例,采用随机数字表法分为建模集(n=225)与验证集(n=149)。分析VAP的影响因素,建立诺莫图模型并评估其预测价值。结果VAP组病人年龄[(70.56±6.33)岁比(68.01±6.06)岁]、急性生理和慢性健康(APACHEⅡ)评分[(20.44±6.89)分比(12.20±4.60)分]、序贯器官衰竭(SOFA)评分[(7.65±3.32)分比4.12±1.82)分]、有吸烟史比例(71.9%比54.8%)、合并基础疾病≥3种比例(45.6%比18.5%)、过去90 d使用抗生素比例(63.2%比40.5%)、呼吸机通气时长≥4 d比例(77.2%比40.5%)、再次插管比例(80.7%比46.4%)较非VAP组升高(P<0.05)。logistic回归分析结果示,合并基础疾病≥3种(OR=2.78,P=0.027)、APACHEⅡ评分(OR=9.46,P<0.001)、SOFA评分(OR=2.99,P=0.010)、过去90 d使用抗生素(OR=2.71,P=0.015)、呼吸机通气时长≥4 d(OR=3.24,P=0.006)、再次插管(OR=3.65,P=0.004)是发生VAP的独立危险因素。建模集及验证集校准曲线结果均显示,构建的诺莫图预测模型校准度较好,ROC曲线下面积分别为0.87[95%CI:(0.82,0.93)]、0.83[95%CI:(0.75,0.92)]。结论通过合并基础疾病≥3种、APACHEⅡ评分、SOFA评分、过去90 d使用抗生素、呼吸机通气时长≥4 d、再次插管等危险因素建立的诺莫图模型对老年COPD急性加重病人发生VAP具有较好的预测价值。

呼吸机相关性肺炎病原菌分布特点及发病影响因素分析

目的:分析呼吸机相关性肺炎(ventilator associated pneumonia,VAP)患者的肺部病原菌分布情况,并探讨VAP发病的影响因素。方法:采用回顾性研究方法,选取2018年1月至2021年12月在山西医科大学第一医院及阳泉市第一人民医院接受机械通气治疗的1164例患者作为研究对象,均留取痰标本进行病原菌检测。收集研究对象一般资料(年龄、性别、住院时间、手术情况)、机械通气时长及次数、尿管和中心静脉导管留置时长及次数、抗菌药物使用时长及次数、痰标本的病原菌情况等信息。分析VAP患者肺部病原菌分布特点,并应用多因素logistic回归模型探究研究对象发生VAP的影响因素。结果:1164例研究对象中,171例(14.69%)发生VAP。171例VAP患者下呼吸道分泌物或气管插管终端分泌物中共检出378株病原菌,其中,革兰阴性菌298株(78.84%),革兰阳性菌66株(17.46%),真菌14株(3.70%);肺炎克雷伯菌、鲍曼不动杆菌是主要病原菌,分别占23.81%(90/378)、14.81%(56/378)。多因素logistic回归分析显示,手术[OR(95%CI)=2.506(1.640~3.828)]、住院时间≥14 d[OR(95%CI)=2.749(8.424~28.968)],以及留置尿管[OR(95%CI)=14.208(5.285~38.192)]均是接受通气治疗患者发生VAP的独立影响因素。结论:条件致病菌是造成机械通气治疗患者呼吸道感染的主要致病菌;对于实施手术、住院时间较长,以及留置尿管的患者,要警惕其发生VAP的风险。