外科重症监护室呼吸机相关性肺炎危险因素分析及护理对策

目的分析外科重症监护室患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的危险因素,并制定针对性的护理对策。方法回顾性分析2012年1—12月广州市某三级甲等医院外科重症监护室收治的104例机械通气超过48 h患者的临床资料,并将患者分为VAP和非VAP组,先以单因素分析筛选出有统计学意义的变量,再使用逐步Logistic回归分析确定VAP的显著独立危险因素,并实施针对性护理措施。结果单因素分析显示,机械通气时间、入住外科重症监护室时间、基础疾病、中心静脉置管、急诊、插管方式、输血史、镇静评分、雾化吸入、昏迷、激素、血清白蛋白、上机前48 h使用抗生素、抑酸剂等14项因素差异有统计学意义(P0.05);但多因素分析只有机械通气时间、昏迷进入回归方程,是外科重症监护室VAP的危险因素,OR值分别为2.684和7.547。结论通过对外科重症监护室VAP危险因素的研究分析,于制定科学的护理对策,以有效降低VAP的发生率。

Risk Factors of Ventilator Associated Pneumonia in Surgical Intensive Care Unit and Its Nursing Measures

Objective To explore the risk factors of ventilator associated pneumonia（VAP） and to develop targeted nursing measures in surgical Intensive Care Unit（ICU）. Methods A retrospective analysis was conducted with clinical data of 104 mechanically ventilated patients treated more than 48h in surgical ICU, and the patients were divided into VAP group and non-VAP group. Risk factors with statistical significance were first screened with univariate analysis, and independent risk factors for VAP were identified with stepwise logistic regression analysis, then appropriate nursing interventions based on independent risk factors were performed. Results Univariate analysis indicated that duration of mechanical ventilation, length of stay in surgical ICU, underlying diseases, PICC, emergency, intubation way, history of blood transfusion, OAAS score, coma, hormone, ALB, antibiotics 48h before ventilation and antacid were significant factors affecting VAP in surgical ICU（P0.05） but multiple-factor analysis showed that only duration of mechanical ventilation（OR=2.684） and coma（OR=7.547） entered into regression equation and were risk factors for VAP. Conclusion The study on VAP risk factors is beneficial to effective reducing of VAP incidence in surgical ICU.