摘要
目的了解新生儿呼吸机相关性肺炎（VAP）的临床特征和高危因素，为VAP的预防和治疗提供借鉴。方法对2005年1月至2006年12月入住华盛顿大学医学院圣路易斯儿童医院NICU的所有新生儿临床资料进行回顾性分析。结果682例接受了机械通气的患儿中，527例机械通气时间≥48h，其中发生VAP79例，按体质量分层的每1000个呼吸机通气日VAP发生率分别是≤1000g组6．3，1001—1500g组5．8，1501～2500g组5.6，〉2500g组3．6。病原菌以革兰阴性杆菌为主，占86．09％，其中最常见的是铜绿假单胞菌、肠杆菌、肺炎克雷白菌、嗜麦芽窄食单胞菌和黏质沙雷菌。革兰阳性球菌主要为肠球菌和金黄色葡萄球菌。Logistic回归分析发现，低胎龄和机械通气时间是新生儿VAP的独立预测因素，OR及95％C1分别是0．886（0．839～0．943）和1．037（1．027～1．046）。结论VAP在低胎龄儿中发生率较高，可能是导致其住院时间延长的原因之一；尽可能缩短机械通气时间可能会降低VAP的发生率。
Objective To determine the prevalence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia （VAP） in neonates. Methods Data were collected retrospectively among neonates admitted to NICU in St. Louis Children＇s Hospital in Washington University School of Medicine between January 1,2005 and December 31,2006. Results A total of 682 patients were mechanically ventilated and 79 episodes of VAP occurred in 527 patients who were mechanically ventilated for more than or equal to 48 h. VAP prevalence were 6. 3,5.8,5.6 ,and 3.6 per 1 000 ventilator days for patients with birth weight ≤ 1 000 g, 1 001 - 1 500 g, 1 501 - 2 500 g, and 〉 2 500 g, respectively. By multivariate logistic regression analysis, smaller gestational age and longer duration of mechanical ventilation were found to be predictive of VAP （odds ratio：0. 886 and 1. 037;95% confidence interval：0. 839 - 0. 943 and 1.027 - 1.046）. Patients with VAP had prolonged length of stay in NICU [ （ 103.6 ± 69. 1 ） d vs （42. 8 ± 46.5 ） d]. Gram-negative bacilli were the most commonly isolated organisms （ 86.09% ）. Conclusion VAP occurred at higher rates in neonates with smaller gestational age and might be associated with increased length of stay. Developing a standard- ized assessment of readiness to wean mechanical ventilatory support would be useful in this patient population.
出处
《中国小儿急救医学》
CAS
2009年第2期134-136,139,共4页
Chinese Pediatric Emergency Medicine
关键词
呼吸机相关性肺炎
婴儿
新生
危险因素
病原学
Ventilator-associated pneumonia
Infant, newborn
Risk factor
Etiology
