巢式病例对照研究在通气相关肺炎危险因素调查中的应用

目的研究通气相关肺炎（ＶＡＰ）的致病危险因素。方法采用巢式病例对照研究的方法，对５８例确诊为通气相关肺炎（ＶＡＰ）的病例，按同科室、同性别、年龄相同或相近（±５岁），入院时间相同或相近（＜１周），病情相似，１∶１配以５８例对照探讨ＶＡＰ的危险因素。结果对２０多种可能的危险因素进行单因素分析。有１６种呈显著性差异。对这１６种主变量进一步进行多因素条件性Ｌｏｇｉｓｔｉｃ回归分析表明：基础病情重（ＯＲ＝９．４０）、留置胃管（ＯＲ＝８．８６）、患者意识状态差（ＯＲ＝８．３９）、气管切开（或插管）时间长（＞２周）（ＯＲ＝６．８９）、有颅脑外伤（ＯＲ＝６．６０）、频繁更换呼吸机接头插管（ＯＲ＝６．４４）、应激性溃疡预防用药（ＯＲ＝５．５２）、住院时间长（＞１月）（ＯＲ＝４．３１）为ＶＡＰ发生的独立危险因素。结论ＶＡＰ的发生是多因素综合作用的结果，且证明存在胃→咽→下呼吸道的逆行感染途径

Risk factors of ventilator associated pneumonia: A nested case-control study

OBJECTIVE To explore the risk factors of ventilator associated pneumonia (VAP) was studied. METHODS The nested case-control study was taken. Fifty eight VAP patients diagnosed according to the Standard of Chinese Society of Nosocomial Infection Control and the same number patients selected from same department and in the similiar sex and age grade, which was not suffered from VAP, were analyzed. RESULTS By analyzing more than twenty factors, the differences of sixteen factors were of significance. The results of multiple stepwise logistic regression showed that: Primary disease serious (OR=9.40), nasogastric tubes (OR=8.86), consciousness (OR=8.39), mechanical ventilation (OR=6.89), trauma of brain (OR=6.60), changing the joint of ventilator equipment frequently (OR=6.44), prophylaxis of stress ulcer (OR=5.52), long time in hospital (OR=4.31) et al. Methylene blue was found in the secretion of throat and lower respiratory tract two days after perfusion through nasogastric tubes. CONCLUSION It was suggested that there was a retrograde route from gastric to throat and lower respiratory tract and VAP was the result of multiple risk factors.