摘要
目的探讨气管切开患者院内获得性肺炎(HAP)的高危因素。方法回顾已气管切开≥5d的患者188例,根据是否发生HAP,分为感染组48例和非感染组140例,两组患者在性别、年龄、意识障碍、活动受限、反流误吸、糖尿病、存在器官功能不全、卒中或脑外伤、免疫抑制、慢性阻塞性肺疾病≥10年、血清白蛋白、预防性应用抗生素、应用制酸剂、留置胃管、持续声门下吸引、机械通气等方面进行比较,然后纳入二元logistic回归分析,分析气管切开患者HAP的高危因素。结果两组患者在意识障碍、活动受限、反流误吸、存在器官功能不全、预防性应用抗生素、机械通气等方面比较差异均有统计学意义(均P<0.05);通过logistic回归分析,筛选出了3个危险因素,包括反流误吸、存在器官功能不全、预防性应用抗生素,而机械通气是强保护因素。结论气管切开患者发生HAP原因复杂,对于高危患者,有条件者建议机械辅助通气治疗以降低HAP发生率。
Objective To explore the risk factors of hospital-acquired pneumonia in tracheostomy patients.Methods From January 2011 to November 2016,188 patients with tracheostomy ≥5 days in Wenzhou People＇s Hospital were retrospectively reviewed.According to the occurrence of hospital-acquired pneumonia,the patients were divided into infected group（n=48） and non-infected group（n=140）.Clinical features were compared between these two groups,including age,gender,disturbance of consciousness,limited mobility,reflux aspiration,diabetes mellitus,organ dysfunction,stroke or traumatic brain injury,immunosuppression,chronic obstructive pulmonary disease ≥10 years,serum albumin,prophylactic antibiotics treatment,application of antacids,indwelling gastric tube,continuous subglottic secretion drainage and mechanical ventilation.Multivariate Logistic regression analysis was employed to assess independent risk factors for the occurrence of hospital-acquired pneumonia.Results There were statistically significant differences between the two groups in disturbance of consciousness,limited mobility,reflux aspiration,organ dysfunction,prophylactic antibiotics,and mechanical ventilation（P〈0.05）.Logistic regression analysis showed that reflux aspiration,organ dysfunction,prophylactic antibiotics treatment were independent risk factors for hospital-acquired pneumonia,while mechanical ventilation is a strong protective factor.Conclusion The risk factors of hospital-acquired pneumonia in tracheostomy patients were complex.For high-risk patients,if possible,mechanical ventilation is recommended to reduce the incidence of nosocomial pneumonia.
作者
徐建国
林乐丹
徐斌
张庆元
张有超
XU Jianguo;LIN Ledan;XU Bing(Department of ICU,the Wenzhou People＇s Hospital,Wenzhou 325000,China)
出处
《浙江医学》
CAS
2018年第16期1840-1842,1846,共4页
Zhejiang Medical Journal
基金
温州市卫生局基金资助项目(2013B12)
关键词
气管切开
院内获得性肺炎
高危因素
Tracheostomy
Hospital acquired pneumonia
Risk factors
