摘要
目的探讨急诊重症监护病房（EICU）呼吸机相关性肺炎（VAP）的危险因素,以期提高VAP的预防水平。方法对2009年5月-2014年4月758例呼吸机机械通气（MV）患者的临床资料与病原菌资料进行回顾性分析;采用SPSS 18.0软件进行统计分析。结果 758例MV患者中发生VAP176例,发生率为23.2%;单因素分析发现,年龄、机械通气时间、EICU停留时间、留置胃管、再插管、紧急插管、贫血、低白蛋白血症、电解质紊乱、昏迷、原发性肺部疾病、恶性肿瘤、APACHEⅡ评分、抑酸剂的使用、镇静剂的使用、二~四代头孢类药物的使用与VAP的发生具有相关性（P〈0.05）;多因素logistic回归分析发现,APACHEⅡ评分≥18、紧急插管、机械通气时间≥5d、原发性肺部疾病、抑酸剂的使用为发生VAP的独立危险因素。结论积极改善患者整体情况、减少不必要的紧急插管、缩短机械通气时间、减少抑酸剂的使用等措施可能降低VAP的发生。
OBJECTIVE To explore the risk factors for ventilator-associated pneumonia（VAP）in emergency intensive care unit（EICU）so as to improve the level of prevention of VAP.METHODS The clinical data of 758 patients who underwent the mechanical ventilation from May 2009 to Apr 2014 were retrospectively analyzed,the data of the pathogens were observed,and the statistical analysis was performed with the use of SPSS 18.0software.RESULTS Of the 758 patients undergoing the mechanical ventilation,176 had VAP with the incidence rate of23.2%.The univariate analysis showed that the incidence of VAP was associated with the age,mechanical ventilation duration,length of EICU stay,gastric tube indwelling,reintubation,emergency intubation,anemia,hypoalbuminemia,electrolyte disturbance,coma,primary pulmonary disease,malignant tumor,APACHEⅡ score,use of antacids,use of sedatives,and use of second,third,and fourth generations cephalosporins（P〈0.05）.The multivariate logistic regression analysis indicated that the independent risk factors for the VAP included the APACHEⅡscore more than 18 points,emergency intubation,mechanical ventilation duration no less than 5days,primary pulmonary disease,and use of antacids.CONCLUSIONIt is an effective way to actively improve the overall condition of the patients,reduce the unnecessary emergency intubations,shorten the mechanical ventilation duration,and reduce the usage amount of antacids.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第17期3949-3951,共3页
Chinese Journal of Nosocomiology
基金
北京市科委科技计划基金资助项目(Z1311070022131142)
