重症监护室呼吸机相关性肺炎的相关危险因素及其预防措施

【目的】探讨呼吸机相关性肺炎（VAP）的危险因素及其预防措施。[方法】选取2014年5月至2015年5月在本院重症监护室接受机械通气治疗的患者61例，根据患者是否发生VAP分为VAP组和非VAP组。比较两组相关临床指标，对重症监护室VAP肺炎进行单因素和多因素分析。【结果】单因素分析结果显示，VAP组和非VAP组患者在年龄、性别和贫血发生率方面相比较差异无显著性（P〉0．05），两组患者在抗菌药物使用时间、侵入性操作、机械通气时间、APACHEⅡ评分、呼吸道免疫功能低下、胃肠道反流及误吸发生率、管道污染发生率上相比较差异具有显著性（P〈0．05）。Logistic回归分析显示，APACHEⅡ评分达15分以上、机械通气时间达7d以上、管道污染、侵入性操作、呼吸道免疫功能低下、胃肠道反流及误吸是重症监护室VAP的危险因素（P〈0．05）。【结论】机械通气时间超过7d、APACHEII评分超过15分、侵入性操作、呼吸道免疫功能低下、管道污染和胃肠道反流及误吸是重症监护室VAP的危险因素，医务人员在工作当中应该根据这些危险因素和患者的实际情况采取针对性的预防和控制措施。

Analysis of the Risk Factors of Ventilator Associated Pneumonia (VAP) in Intensive Care Unit

Objective]To discuss and analyze the risk factors of ventilator associated pneumonia (VAP) in patients in the intensive care unit and possible preventative measures .[Methods]Sixty‐one patients under‐ground mechanical ventilation treatment in our hospital's intensive care unit from May 2014 to May 2015 were chosen as the study subjects .The patients were divided into two groups according to whether or not the pa‐tients had VAP .The first group had ventilator associated pneumonia (VAP) and the second group of did not have ventilator associated pneumonia (VAP) .The clinical data of the two groups were observed and compared . Single factor analysis and multi‐variable analysis were made regarding VAP in the patients .[Results]The sin‐gle factor analysis showed that age ,gender and incidence of anemia were not statistically different between the two groups ( P > 0 .05) .However ,there were statistically significant differences ( P < 0 .05) in terms of anti‐microbial drug use time ,invasive operation ,mechanical ventilation time ,acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ ) ,respiratory immune dysfunction ,incidence of gastrointestinal reflux and aspiration ,and pipe pollution events .Logistic regression analysis also showed that an APACHE Ⅱ of 15 points or above ,mechanical ventilation time of more than 7 days ,pipe pollution ,invasive operation ,lower im‐mune function of respiratory ,incidence of gastrointestinal reflux and aspiration were risk factors of ventilator associated pneumonia in the intensive care unit ( P < 0 .05) .[Conclusion] A mechanical ventilation time of more than 7 days ,an APACHE Ⅱ score of more than 15 ,use of an invasive operation ,respiratory immuno‐compromised ,pipe pollution ,and gastrointestinal reflux and aspiration are the intensive care unit risk factors of ventilator associated pneumonia .Medical staff should pay attention to the actual situation of patients with these risk factors and take corresponding prevention and control measures .