急诊监护病房机械通气相关性肺炎危险因素与病原学分析

目的：通过研究急诊监护病房（EICU）机械通气相关性肺炎（VAP）的发病危险因素及病原学特点，为VAP防治提供流行病学资料，为制定和采取干预对策提供科学依据。方法：采用前瞻性队列研究，以我院EICU行气管插管或气管切开患者为对象作单因素和Logistic回归分析，筛选VAP发病的危险因素。结果：102例患者行机械通气，其中56例发生VAP，发生率54．9％，将17项变量行单因素分析显示，COPb病史、白蛋白〈25g／L、连续使用抗生素〉3d等11项因素有统计学意义。Logistic回归分析显示，VAP的独立发病危险因素有同时使用2种以上抗生素、重复气管插管、APACHEⅡ评分〉15分、躯干平卧位、机械通气时间延长。VAP的病原菌为多重耐药菌。结论：EICU发生VAP是多种因素共同作用的结果，应采取综合性干预对策，以切实降低感染率，提高救治成功率。

Risk factors of ventilator associated pneumonia in emergency intensive care unit and its pathogenic analysis

Objective： To study the risk factors and pathogenic character of ventilator associated pneumonia （VAP） in emergency intensive care units（EICU）, in order to offer basic epidemiological data for the prevention of VAP. Method：A prospective cohort study on VAP was carried out in intubed or tracheotomied patients in EICU. Single factor analysis and muti--variable logistic regression analysis were adopted to identify the possible risk factors of VAP. Result： 102 patients were enrolled in the study, of which 56 were diagnosed as having VAP, the incidence of VAP was54.9 %. Single factor analysis showed that history of COPD, use of H2 - receptor blocker, the days of antibiotic use, the type of antibiotics, enteral feeding, APACHE Ⅱ scores,the duration of mechanic venti- lation, hypoalbuminemia, tra cheotomy , reintubation, supine body position and conscious disturbance were related to the occurrence of VAP. Multi-variable logistic analysis showed statistical significance in combination of over two type of antibiotics, reintubation, APACHE Ⅱ scores over 15, supine body position and prolongation of mechanic ventilation. The main pathogen of VAP was multidrug--resistance of bacteria. Conclusion：Various factors contributed to VAP in EICU. General intervention strategy should be adopted in the control of ventilator associated pneumonia to low the infection rate and raise the rate of rescue.