摘要
目的:探讨无创机械通气患者发生医院获得性肺炎(hospital acquired pneumonia,HAP)的相关危险因素,从而为临床实施干预提供参考依据。方法:回顾性分析某三甲医院2014年12月至2016年2月呼吸内科重症监护室440例无创机械通气患者的临床资料,采用logistic回归分析发生HAP的高危因素。结果:440例无创机械通气患者中发生HAP15例,感染发生率为3.41%;单因素分析结果显示,合并糖尿病、APACHEⅡ评分>18分、ICU住院天数>10 d、无创机械通气时间>7 d、血清白蛋白水平低于25 g/L、留置胃管、呼吸机管路使用时间>7 d以及人工吸痰都与无创机械通气患者发生HAP具有相关性(P<0.05);多因素分析结果显示,APACHEⅡ评分>18分(OR=4.665,95%CI=1.2~18.134,P=0.026)、ICU住院天数>10 d(OR=11.261,95%CI=2.234~56.757,P=0.003)以及人工吸痰(OR=12.561,95%CI=2.846~55.441,P=0.000)是无创机械通气患者发生HAP的独立危险因素。结论:病情危重、ICU住院时间较长(>10 d)以及患者自主排痰能力较差需人工吸痰的无创机械通气患者发生HAP的感染率较高,如果患者存在以上危险因素,应加强对HAP的预防。
Objective：To explore the risk factors for hospital acquired pneumonia（HAP）in patients with non-invasive mechanical ventilation so as to provide some guidance for clinical intervention. Methods：The clinical data of patients with non-invasive mechanical ventilation were retrospectively analyzed. Results：HAP occured in fifteen patients（out of 440 patients）with non-invasive ventilation acquired pneumonia with the infection rate being 3.41%. The results of univariate analysis showed that the incidence of HAP in patients with noninvasive mechanical ventilation was associated with diabetes mellitus,APACHEⅡscore 〉18 points,ICU stay 10days,duration of noninvasive ventilation 〉7 days,serum albumin lower than 25 g/m L,indwelling gastric tube and artificial sputum suction（P〈0.05）;the multivariate logistic regression analysis showed that APACHE Ⅱ score 18 points（OR=4.665,95%CI=1.2 to18.134,P=0.026）,ICU stays 〉10 days（OR=11.261,95%CI=2.234 to 56.757,P=0.003）and repeated artificial sputum（OR=12.561,95%CI=2.846 to 55.441,P=0.000） were the independent risk factors for the hospital acquired pneumonia in patients（P〈0.05）.Conclusion：More attention should be paid to the patients with non-invasive mechanical ventilation when they are in critical condition,staying in ICU for a long time（〉10 days）and needing sputum suction to prevent HAP.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2017年第1期58-62,共5页
Journal of Chongqing Medical University
基金
重庆医科大学附属第一医院护理科研课题资助项目(编号:HLJJ2015-16)
关键词
无创机械通气
医院获得性肺炎
高危因素
non-invasive mechanical ventilation
hospital acquired pneumonia
risk factor
