PICU患儿发生呼吸机相关性肺炎的影响因素

目的 探讨儿童重症监护病房(pediatric intensive care unit,PICU)患儿发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的影响因素,并构建预测模型.方法 回顾性分析2015年1月～2019年6月本院PICU收治的600例行机械通气治疗的患儿,统...

Influencing factors and prediction model of ventilator-associated pneumonia in pediatric intensive care unit

Objective To explore the influencing factors of ventilator-associated pneumonia(VAP)in pediatric intensive care unit(PICU),and to build a predictive model.Methods From January 2015 to June 2019,the incidence of VAP in 600 patients with mechanical ventilation in PICU was analyzed retrospectively.Logistic regression method was used to analyze the risk factors affecting VAP,and a prediction model was built based on the analysis results.Then ROC curve method was used to analyze the value of the model to predict VAP.Results VAP was found in 54 of 600 children with PICU,accounting for 9.00%.Mechanical ventilation time(OR=6.375,95%CI:3.298~12.32),bronchoscopy(OR=1.979,95%CI:1.025~3.823),intubation(OR=2.553,95%CI:1.329~4.906),steroid hormone(OR=4.758,95%CI:2.353~9.62),proton pump inhibitor(OR=2.377,95%CI:1.124~5.025)were independent risk factors for VAP(P<0.05).According to the Logistic regression analysis results,the prediction model was fitted:PI=1.852X1+0.683X2+0.937X3+1.56X4+0.866X5-0.476(X1:mechanical ventilation time;X2:bronchoscopy;X3:re intubation;X4:steroid hormone use;X5:proton pump inhibitor use).The greater the PI,the higher the risk of VAP.The ROC curve was drawn with PI as the test variable and actual VAP as the state variable.The results showed that AUC was 0.845(SE=0.026,95%CI:0.795~0.895,P<0.001),with 89.96%of sensitivity and 77.50%of specificity.Conclusion The time of mechanical ventilation,bronchoscopy,intubation,steroid hormone and proton pump inhibitor are the factors influencing VAP.The prediction model established in this study has certain value for the prevention and treatment of VAP.