ICU呼吸机相关性肺炎的危险因素分析

目的分析ICU呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）发生的危险因素，为防治VAP提供依据。方法收集ICU机械通气 > 48 h病人112例，其中经临床诊断为VAP 42例（VAP组），非VAP 70例（非VAP组）。比较2组病人在年龄、性别、意识状态、基础疾病、住院时间、机械通气时间等方面的差异。结果2组病人在气管切开、肠内营养、频繁吸痰、气压治疗、早期康复治疗、住院时间、机械通气时间、抗菌药物联用方面差异均有统计学意义（P < 0.01）。多因素logistic回归分析结果显示，病人气管切开、住院时间长、机械通气时间长和抗菌药物联用是VAP发生的独立危险因素（P < 0.05~P < 0.01）。结论VAP可由多种高危因素引起，应采取针对性预防措施，加强VAP危险因素监测，严格执行无菌操作制度，降低VAP发生率。

Analysis of the risk factor of the ventilator-associated pneumonia in ICU

ObjectiveTo analyze the risk factors of ventilator-associated pneumonia(VAP) in intensive care unit(ICU), and provide scientific evidence for prevention and treatment of VAP.MethodsA total of 112 patients treated with mechanical ventilation > 48 h were divided into the VAP group(42 cases) and non-VAP group(70 cases) according to clinical diagnosis.The age, sex, state of consciousness, underlying disease, hospitalization time, and mechanical ventilation between two groups were compared.ResultsThe differences of the tracheostomy, enteral nutrition, aspiration frequence, air pressure therapy, early rehabilitation, hospitalization time, mechanical ventilation time and antimicrobial drug use between two groups were statistically significant(P < 0.01).Multivariate logistic regression analysis showed that the tracheotomy, long hospitalization time, long time of mechanical ventilation, antimicrobial drug combination were the independent risk factor of VAP.ConclusionsVAP can be caused by several high-risk factors.Taking the targeted preventive measures, strengthening the VAP risk factor monitoring and strict implementing the sterile operation system can reduce the incidence of VAP.