重症颅脑损伤患者呼吸机相关性肺炎危险因素与病原菌分析

目的 分析颅脑损伤患者重症监护病房(ICU)呼吸机相关性肺炎(VAP)的危险因素.方法 回顾性研究162例严重颅脑损伤转入ICU治疗患者的临床资料,单因素分析筛选出有统计学意义的危险因素,并将其纳入logistic回归分析确定VAP的独立危险因素,并对呼吸道标本进行细菌分离培养.结果 纳入研究患者有40例发生VAP,发生率为24.7％,logistic回归分析显示,早期给予肠内营养是VAP发生的保护性因素,气管切开、吸烟史和巴比妥是VAP发生的独立危险因素(P＜0.05)；革兰阳性球菌占病原菌总数的63.8％,其中甲氧西林敏感金黄色葡萄球菌占34.5％.结论 气管切开、吸烟史、巴比妥是VAP发生的独立危险性因素,早期给予肠内营养支持是发生VAP的保护性因素,甲氧西林敏感金黄色葡萄球菌是VAP的主要致病菌.

Risk factors for ventilator-associated pneumonia in severe head trauma patients and pathogen analysis

OBJECTIVE To investigate the risk factors of VAP in head-trauma patients in ICU.METHODS Retrospective study was performed for the clinical data from 335 head-trauma patients treated in the ICU;several statistically significant risk factors were screened out with univariate analysis;then independent risk factors were determined with multivariate stepwise logistic regression analysis.The isolation and culture of bacteria from respiratory tract specimens were performed.RESULTS Totally 40 patients enrolled in the study developed VAP.The incidence was 24.7%.Multivarite stepwise logistic regression analysis revealed that early enteral feeding was a protective factor for VAP.Tracheal incision,history of smoking,and the use of barbiturate were independent risk factors for VAP.Gram-positive cocci were the most common pathogens involved in VAP(63.5%),of which methicillin-susceptible Staphylococcus aureus was the majority(34.5%).CONCLUSION This study confirms that early enteral feeding is a protective factor for VAP;the use of barbiturate,tracheotomy and history of smoking are independent risk factors for VAP,whereas methicillin-susceptible S.aureus is found as the major pathogen involved in VAP.