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综合ICU气管切开患者并发下呼吸道感染的影响因素分析及预防对策 被引量:27

An analysis on influencing factors and preventive measures of patients with complication of lower respiratory tract infection after tracheotomy in intensive care unit
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摘要 目的:分析综合重症加强治疗病房(ICU)气管切开患者并发下呼吸道感染的影响因素,探讨其预防对策。方法采用回顾性研究方法。选择杭州市第三人民医院综合ICU 2015年3月至2016年3月收治的382例气管切开患者为研究对象,其中并发下呼吸道感染的153例患者为感染组,无下呼吸道感染的229例患者为非感染组。对两组患者的性别、年龄、肺气肿、呼吸衰竭(呼衰)、入住ICU时间、使用抗菌药物种类、抗菌药物使用时间、雾化吸入、气道开放时间、侵入性操作、手术时机等资料进行单因素分析,将单因素分析有统计学意义的数据进行多因素logistic回归分析,筛选出影响ICU气管切开患者并发下呼吸道感染的独立危险因素。结果感染组与非感染组年龄、肺气肿、原发病、呼衰、入住ICU时间、使用抗菌药物种类、抗菌药物使用时间、雾化吸入、气道开放时间、使用呼吸机时间、侵入性操作比较差异均有统计学意义(均P<0.05)。单因素分析显示:年龄〔优势比(OR)=5.868,95%可信区间(95%CI)=2.790~10.342,P=0.000〕、脑出血(OR=3.920,95%CI=2.250~6.540,P=0.034)、脑梗死(OR=1.048,95%CI=1.005~1.092,P=0.027)、肺气肿(OR=5.995,95%CI=2.851~8.374,P=0.001)、呼衰(OR=5.022,95%CI=2.107~10.244,P=0.009)、入住ICU时间(OR=4.968,95%CI=2.461~8.236,P=0.003)、气道开放时间(OR=4.149,95%CI=1.298~9.027, P=0.019)、使用抗菌药物种类(OR=4.364,95%CI=1.166~9.339,P=0.029)、抗菌药物使用时间(OR=3.944,95%CI=1.546~7.622,P=0.027)、雾化吸入(OR=2.052,95%CI=1.150~5.042,P=0.014)、侵入性操作(OR=3.467,95%CI=2.869~8.956,P=0.000)、手术时机(OR=0.366,95%CI=0.175~0.763,P=0.037)、使用呼吸机时间(OR=0.981,95%CI=0.966~0.996,P=0.041)� ObjectiveTo analyze the influencing factors and explore the countermeasures of patients with complication of lower respiratory tract infection after tracheotomy in intensive care unit (ICU).Methods The clinical data of 382 patients with tracheotomy admitted to ICU of Hangzhou Third People's Hospital from March 2015 to March 2016 were retrospectively analyzed, including 153 patients with complicated lower respiratory tract infection as the infected group, and 229 cases without the infection as the no-infected group. The gender, age, emphysema, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used, time length of applying antimicrobial agents, aerosol inhalation, airway opening time, invasive operation, surgical opportunity and so on were analyzed in the two groups by univariate analysis. In order to screen out the independent risk factors for patients with complication of lower respiratory tract infection after tracheotomy in ICU, the multiple logistic regression analysis was used on the statistically significant risk factors found by using univariate analysis.Results There were statistically significant differences in age, emphysema, primary disease, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used,time length of using antimicrobial agents, aerosol inhalation, airway opening time, invasive operation and the time of mechanical ventilation between infected group and non-infected group (allP 〈 0.05). The single factor analysis showed that age [odds ratio (OR) = 5.868, 95% confidence interval (95%CI) = 2.790-10.342,P = 0.000), cerebral hemorrhage (OR = 3.920, 95%CI = 2.250-6.540,P = 0.034), cerebral infarction (OR = 1.048, 95%CI = 1.005-1.092,P = 0.027), emphysema (OR = 5.995, 95%CI = 2.851-8.374,P = 0.001), respiratory failure (OR = 5.022, 95%CI = 2.107-10.244, P = 0.009), time of admission to ICU (OR = 4.968,95%CI = 2.461-8.236,P = 0.003), airway opening time (OR = 4.149, 95%CI = 1.298-9.027,P = 0.019)
作者 吴都 潘金波
出处 《中国中西医结合急救杂志》 CAS 北大核心 2016年第5期453-457,共5页 Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金 国家自然科学基金青年科学基金项目(81302935)
关键词 重症加强治疗病房 气管切开 下呼吸道感染 影响因素 对策 Intensive Care Unit Tracheotomy Lower respiratory tract infection Influencing factors Countermeasures
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