摘要
目的分析呼吸机相关性肺炎(VAP)的危险因素及其口腔护理预防效果,为降VAP提供参考依据。方法收集2012年12月-2015年5月医院心胸外科210例行机械通气患者临床资料,将其随机分为对照组和干预组,每组各105例,对照组患者给予常规口腔护理,干预组患者采用口腔生理盐水冲洗,记录两组患者VAP发生及预后;对机械通气患者发生VAP的危险因素进行多因素logistic回归分析,采用SPSS 16.0软件进行统计分析。结果干预组患者VAP发生率、病死率分别为14.29%、4.76%,显著低于对照组患者的44.76%、13.33%,差异均有统计学意义(P<0.05);VAP患者共检出病原菌85株,其中革兰阴性菌、革兰阳性菌、真菌分别占63.53%、30.59%、5.88%;年龄≥65岁、住院时间≥21d、机械通气时间≥14d、APACHEⅡ评分≥18分、有侵入性操作、意识障碍、合并基础疾病、预防性应用抗菌药物是机械通气患者发生VAP的危险因素(P<0.05);其中年龄≥65岁、机械通气时间≥14d、APACHEⅡ评分≥18分、侵入性操作是患者发生VAP的独立危险因素(P<0.05)。结论口腔生理盐水冲洗可降低机械通气患者呼吸机相关性肺炎发生率,年龄、机械通气时间、APACHEⅡ评分、侵入性操作为机械通气患者发生VAP的危险因素。
OBJECTIVE To explore the associated risk factors of ventilator-associated pneumonia（VAP）and effect of oral care in prevention,so as to provide basis for reducing VAP incidence.METHODS Totally 210 mechanically ventilated patients from Dec.2012 to May 2015 in the hospital were collected.They were randomly divided into control and intervention groups,105 cases in each group.Patients in the control group were given routine oral care,while patients in the intervention group were given oral saline care.VAP occurrence and prognosis of two groups were recorded.Risk factors for mechanical ventilation in patients with VAP were analyzed by multivariate logistic regression analysis.The results were analyzed by using SPSS 16.0software for statistical analysis.RESULTS VAP incidence and mortality in the intervention group were 14.29% and 4.76%,which were significantly lower than 44.76% and 13.33%in the control group（P〈0.05）.Totally 85 strains of pathogens were detected in VAP patients,including gram-negative bacteria,gram-positive bacteria,fungi,accounting for 63.53%,30.59%,5.88%.Age≥65years,length of stay≥21d,mechanical ventilation≥14d,APACHEⅡ score≥18points,invasive procedures,unconsciousness,complication with underlying diseases,and prophylactic use of antibiotics were risk factors for the occurrence of VAP in mechanically ventilated patients（P〈0.05）.Age ≥ 65 years,duration of mechanical ventilation ≥ 14 d,APACHEⅡ score ≥18points,and invasive procedures were independent risk factors（P〈0.05）.CONCLUSION The results show that oral saline irrigation can reduce incidence of ventilator-associated pneumonia in mechanically ventilated patients.Age,duration of mechanical ventilation,APACHEⅡ score and invasive operation of mechanical ventilation are risk factors for VAP in mechanically ventilated patients.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第3期698-699,705,共3页
Chinese Journal of Nosocomiology
基金
海南省重点科研基金资助项目(1421320.27A1004)
