综合ICU多发伤呼吸机相关性肺炎的危险因素研究

目的 探讨多发伤患者呼吸机相关性肺炎(VAP)发生的危险因素。 方法 回顾分析综合ICU 2013年1~12月收治的多发伤患者的病历资料,分析VAP相关危险因素。 结果 98例患者中,发生VAP 35例,发病率为35.7％。单因素分析显示,患者住ICU天数、连续应用抗生素时间、气管插管天数、呼吸机使用时间、鼻饲、头颈部和胸部创伤严重程度等级(ISS)等是VAP发生的危险因素。Logistic回归分析显示,气管插管天数、头颈部和胸部损伤的严重程度是多发伤患者VAP发生的独立危险因素。 结论 多发伤患者VAP的发生率高,对头颈部和胸部创伤严重、气管插管时间长的患者应采取有效的VAP防控措施。

The risk factors of ventilator-associated pneumonia among multiple-injury patients in the intensive care unit

Objective To investigate the risk factors of ventilator-associated pneumonia in multiple-injury patients. Methods Multiple-injury patients enrolled to our intensive care unit(ICU) from January to December 2013 were studied on their medical records and risk factors of ventilator-associated pneumonia. Results Among all the 98 patients, 35 suffered from VAP, with an occurrence rate of 35.7%. Single-factor analysis showed that the stay length in ICU,duration of using antibiotics continuously,days of tracheal intubation and mechanical ventilation, as well as nasal feeding and severity of injury in the head-neck and chest were the risk factors of VAP. The logistic regression analysis showed that the duration of tracheal intubation and severity of injury in the head-neck and chest injury were the independent risk factors. Conclusion Multiple-injury patients with mechanical ventilation have a high occurrence of VAP. Better preventing and controlling measures against VAP should be adopted for patients who need long-term tracheal intubation with the severe head-neck and chest injury.