摘要
目的分析新生儿呼吸窘迫综合征(NRDS)合并呼吸机相关性肺炎(VAP)患儿死亡的相关因素并提出相应防控措施。方法回顾性分析2013年2月-2019年9月277例NRDS合并VAP患儿的临床资料,收集并记录相关临床资料,计算死亡率并对相关因素进行单因素与多因素分析。结果NRDS合并VAP患儿死亡率22.02%;出生胎龄<28周、羊水污染、胎膜早破、入院时日龄<7 h、出生体质量<1000 g、APACHEⅡ评分>15分、机械通气时间>7 d、感染类型(迟发型)、并发症、多重耐药菌感染、PCT>0.5μg/L共11个因素是NRDS合并VAP患儿死亡的危险因素(P<0.05);肺表面活性物质是NRDS合并VAP患儿死亡的保护因素(P<0.05)。多因素分析显示出生体质量<1000 g、出生胎龄<28周、机械通气时间>7 d、多重耐药菌感染、降钙素原(PCT)>0.5μg/L共5个因素是NRDS患儿VAP死亡的独立危险因素(P<0.05)。结论NRDS合并VAP患儿死亡率较高,加强超早产-极低体质量儿的管理,做好多重耐药菌感染的防控,早期拔管减少不必要的机械通气时间是减少NRDS合并VAP患儿死亡的主要措施;血清PCT监测可预测NRDS合并VAP患儿治疗效果并为临床干预提供依据。
Objective To analyze the related factors of death in neonates with respiratory distress syndrome(NRDS)combined with ventilator-associated pneumonia(VAP)and put forward corresponding prevention and control measures.Methods The clinical data of 277 children with NRDS combined with VAP from February 2013 to September 2019 were retrospectively reviewed.The clinical data were collected and recorded,and the related factors of death were analyzed by single and multiple factors.Results The mortality rate of children with NRDS combined with VAP was 22.02%;birth gestational age<28 weeks,amniotic fluid pollution,premature rupture of membranes,age at admission<7 h,birth weight<1000 g,APACHE II score>15 points,mechanical ventilation time>7 d,11 types of infection(late type),complications,multi-drug resistant infection,PCT>0.5μg/L were risk factors for death of children with NRDS and VAP(P<0.05);pulmonary surfactants were NRDS with VAP The protective factors of death in children(P<0.05).Multivariate analysis showed that birth weight<1000g,birth gestational age<28 weeks,mechanical ventilation time>7 d,multi-drug resistant infection,procalcitonin(PCT)>0.5μg/L were 5 factors in children with NRDS which were independent risk factors for death(P<0.05).Conclusion The mortality of children with NRDS combined with VAP was high.Strengthening the management of super preterm and extremely low weight infants,doing a lot of prevention and control of multidrug-resistant bacteria infection and early dialing to reduce unnecessary mechanical ventilation time were the main measures to reduce the death of children with NRDS and VAP,and the serum calcitonin monitoring can predict the effect of the treatment of children with NRDS combined with VAP and pre provide basis for clinical work.
作者
谢朝云
熊芸
蒙桂鸾
杨忠玲
陈应强
Xie Zhaoyun;Xiong Yun;Meng Guiluan;Yang Zhongling;Chen Yingqiang(The Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,China)
出处
《湖北民族大学学报（医学版）》
2020年第1期35-38,共4页
Journal of Hubei Minzu University(Medical Edition)
基金
贵州省科技厅联合项目(黔科合LH字[2014]7162号)
贵州省黔南州社会发展科技项目(黔南科合社字[2018]7号)。
