新生儿呼吸机相关性肺炎危险因素分析

目的探讨新生儿呼吸机相关性肺炎(VAP)的危险因素。方法对2008年1月～2010年10月在我院NICU机械通气治疗>48 h的90例患儿的临床资料进行回顾性分析。根据是否发生VAP分为VAP组与非VAP组,以胎龄、出生体重、机械通气时间等15个因素为预想危险因素进行单因素分析,总结各危险因素与VAP的相关性。结果 90例机械通气患儿发生VAP 49例,发生率为54.4%。在胎龄、出生体重、机械通气时间、反复气管内吸引、留置胃管、再插管、肺透明膜病、营养不良、中枢神经抑制剂及静脉注射用丙种球蛋白应用方面,VAP组与非VAP组差异有统计学意义(P<0.05)。结论缩短机械通气时间,避免反复气管内吸引和再插管,应用大剂量静脉注射用丙种球蛋白等措施可降低新生儿VAP的发生率。

To study the risk factors of neonatal ventilator- associated pneumonia

Objective To study the risk factors of neonatal ventilator-associated pneumonia(VAP).Methods Ninety cases from January 2008 to October 2010 in our hospital NICU of children′s clinical data were retrospectively analyzed,whose mechanical ventilation time was over 48hrs.Based on the occurrence of VAP,those cases were divided into VAP group with 49 patients and non-VAP group with 41 cases.Gestational age,birth weight,duration of mechanical ventilation and other factors about 15 risk factors were expected to summarize the association with the risk factors and VAP by use of a single-factor analysis.Results Forty-nine cases in 90 children experienced occurrence of VAP with mechanical ventilation,and the incidence rate of VAP was 54.4%.In terms of the gestational age,birth weight,duration of mechanical ventilation,repeated endotracheal suctioning,indwelling stomach tube,reintubation,hyaline membrane disease,malnutrition,central inhibitors and the application of intravenous gamma globulin,there were significant differences(P<0.05) in VAP group and non-VAP.Conclusion Shortening duration of mechanical ventilation,avoiding repeated endotracheal reintubation,applying of high-dose intravenous immunoglobulin and other measures could reduce the incidence of neonatal VAP.