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重症监护病房无创机械通气患者医院获得性肺炎的病原菌分布与影响因素 被引量:4

Pathogenic bacterium distribution and influencing factors of hospital-acquired pneumonia for patients received non-invasive mechanical ventilation in the intensive care unit
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摘要 目的探讨重症监护病房无创机械通气患者医院获得性肺炎(HAP)的病原菌分布与影响因素。方法选择我院重症监护病房598例行无创机械通气的患者为研究对象,统计患者HAP的发生情况及致病菌情况,对可能导致患者发生HAP的相关因素进行统计学分析。结果598例患者中,41例(6.86%)发生了HAP;共分离出55株致病菌,其中革兰氏阳性菌15株(27.27%),革兰氏阴性菌32株(58.18%),真菌8株(14.55%)。Logistic回归分析结果显示,年龄≥60岁、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分≥18分、合并意识障碍、无创通气时间≥7 d、呼吸机管道使用时间≥3 d及使用质子泵抑制剂是患者发生HAP的危险因素(OR>1,P<0.05),而每日口腔清洁则是患者发生HAP的保护性因素(OR<1,P<0.05)。结论重症监护病房无创机械通气患者的HAP发生率较高,其主要致病菌为革兰氏阴性菌。年龄≥60岁、APACHEⅡ评分≥18分、合并意识障碍、无创通气时间≥7 d、呼吸机管道使用时间≥3 d及使用质子泵抑制剂的患者更容易发生HAP,而每日口腔清洁则可降低其发生率,临床应予以重点关注。 Objective To investigate the pathogenic bacterium distribution and the influencing factors of hospital-acquired pneumonia(HAP)for patients received non-invasive mechanical ventilation in the intensive care unit.Methods A total of 598 patients received non-invasive mechanical ventilation in the intensive care unit were selected as the research objects.The incidence and pathogenic bacterium of HAP for patients were collected,and the related factors that might lead to HAP in patients were analyzed statistically.Results Among the 598 patients,41 cases(6.86%)developed HAP;55 strains of pathogenic bacterium were isolated totally,including 15 strains(27.27%)of Gram-positive bacterium,32 strains(58.18%)of Gram-negative bacterium,and 8 strains(14.55%)of fungi.The results of Logistic regression analysis showed that age≥60 years old,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score≥18 points,combined with consciousness disturbance,duration of non-invasive ventilation≥7 days,use duration of the ventilator tube≥3 days and use of the proton pump inhibitor were the risk factors of HAP for patients(OR>1,P<0.05),while daily oral cleaning was a protective factor of HAP for patients(OR<1,P<0.05).Conclusion The incidence of HAP is high in patients received non-invasive mechanical ventilation in the intensive care unit,and Gram-negative bacterium is the main pathogenic bacterium.Patients with age≥60 years old,APACHEⅡscore≥18 points,consciousness disturbance,duration of non-invasive ventilation≥7 days,use duration of the ventilator tube≥3 days,and use of proto n pump inhibitor are more likely to develop HAP,while daily oral cleaning can reduce its incidence,which should be focus on in the clinic.
作者 王洁 徐月红 吴炜炜 WANG Jie;XU Yue-hong;WU Wei-wei(EICU,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu 210014,China)
出处 《局解手术学杂志》 2021年第12期1046-1049,共4页 Journal of Regional Anatomy and Operative Surgery
关键词 重症监护病房 无创机械通气 医院获得性肺炎 病原菌 危险因素 革兰氏阴性菌 intensive care unit non-invasive ventilation hospital-acquired pneumonia pathogenic bacterium risk factors Gram-negative bacterium
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