呼吸机相关性肺炎危险因素分析

目的 观察机械通气的患者机体生理生化的改变，探讨其变化对呼吸机相关性肺炎(VAP)发生发展的影响。方法 对所有入住ICU机械通气48小时以上的106例患者，以有无呼吸机相关性肺炎为标志分为两组。观察机械通气时间、潮气量、气道峰压、体温、脉搏、呼吸、检验血气分析、血常规、血电解质、血清白蛋白、免疫球蛋白、血纤维蛋白原、凝血酶原时间、空腹血检及心电图、胸片检查的变化。并收集痰标本进行细菌定量培养，记录并发症。结果 VAP组47例(44％)机械通气时间、体温、脉搏、潮气量、气道峰压、外周血白细胞、血纤维蛋白原、空腹血检均高于无VAP组(P＜0．01)。K^ 、Mg^ 、公清白蛋白、IgG、IgA、凝血酶原时间均低于无VAP组(P＜0．01)。其它各项比较均无显著性差异(P＞0．05)。且绿脓杆菌、金黄色葡萄球菌为VAP最常见致病菌。结论 防止气压伤，采取个体保护性机械通气，可降低VAP的发生率。凝血——损伤——炎症网络的启动，将造成神经——内分泌——免疫网络的紊乱，增加VAP的发生率。Mg^ 、中性白细胞、纤维蛋白原可能直接参与VAP的发生发展。

Analysis on risk factors of ventilator-associated pneumonia

Objective To investigate the changes of the biochemistry and the physiology of the patients of ventilator associated pneumonia.Methods One hundred and six patients were separated into two groups according to presence or absence of ventilator associated pneumonia(VAP),who had mechanical ventilation more than 48 h after admission to intensive care unit.All patients were observed for the time of ventilating,tidal volume,inspiratory peak pressure,body temperature,pulse,respiration,and blood gas analysis,leukocyte count,K +,Na +,Cl +,Ca 2+ ,Mg 2+ ,IgG,IgA,IgM,IgE,fibrination,prothrombin time,blood sugar,electrocardiogram,X chest.Samples for quantitative cultures were used to diagnose VAP,following complications were recorded.Results VAP occurred in 47 patients (44%).Time of mechanical ventilation,body temperature,pulse,inspiratory peak pressure,leckocyte count,fibrination,blood sugar were significantly higher in patients with VAP.Prothromin time,K +,Mg 2+ ,the serum albumin,IgG,IgA were significantly lower in patients with VAP.The most common pathogens causing VAP are bacillus pyocyaneus and staphylococcus aureus.Conclusions Prevention of barotraumas can decrease the occurrence of VAP.Starting the network of the coagulation injury inflammation will cause the disturbance of the network of the nerve endocrine immunization and associate with an increased risk of VAP.Mg 2+ ,leckocyte,and fibrination may participate in the occurrence and development of VAP.