呼吸机相关性肺炎危险因素分析

目的探讨呼吸机相关性肺炎(VAP)的有关危险因素,为临床早期诊断、治疗及预后评估提供参考。方法收集2008年1月至2010年12月期间机械通气时间48 h的132例患者,其中经临床确诊为VAP的32例,非VAP为100例,分别对性别、年龄、机械通气时间、气管切开、留置胃管、血糖、抗生素使用时间、使用激素、制酸剂、APHY+PEEP通气模式、慢性阻塞性肺疾病、昏迷、APACHEⅡ评分等13项危险因素进行单因素分析,并对显著相关性危险因素进行Logistic回归分析。结果单因素分析显示机械通气时间、气管切开、留置胃管、制酸剂、APHY+PEEP通气模式、慢性阻塞性肺疾病、昏迷、APACHEⅡ评分8项指标有显著相关性;多因素回归分析提示机械通气时间、制酸剂、慢性阻塞性肺疾病、昏迷、APACHEⅡ评分这5项指标是VAP独立相关因素。结论 VAP的发生受多种因素影响,临床实践中各因素相互关联影响,应重视这些独立危险因素的预测价值,避免医源性危险因素,降低VAP发病率及病死率。

Analysis of risk factors of ventilator-associated pneumonia

Objective To investigate the risk factors for ventilator-associated pneumonia(ventilator-associated pneumonia,VAP) to provide a reference for the early diagnosis,treatment and prognosis assessment.Methods A total of 132 patients in our hospital from January 2008 to December 2010 whose duration of mechanical ventilation> 48 h was selected.According to clinical diagnosis,32 cases were VAP,100 cases were non-VAP.Thirteen risk factors such as gender,age,mechanical ventilation time,tracheotomy,indwelling stomach tube,blood glucose,use time of antibiotics,the use of hormones,antacids,the APHY PEEP ventilation mode,chronic obstructive pulmonary disease,coma,APACHE Ⅱ score were univariately analysed and the significantly related risk factors underwent Logistic regression analysis.Results Univariate analysis showed that eight indicators like duration of mechanical ventilation,tracheotomy,indwelling stomach tube,antacids,the APHY+PEEP ventilation mode,chronic obstructive pulmonary disease,coma,APACHE Ⅱ score were significantly correlated;multivariate regression analysis indicated that five indicators like duration of mechanical ventilation,antacids,chronic obstructive pulmonary disease,coma,APACHE Ⅱ score were VAP independently associated factors.Conclusion The incidence of VAP is affected by many factors interrelated in clinical practice and the predictive value of these independent risk factors is important,so attention should be paid to avoid iatrogenic risk factors to reduce VAP incidence and mortality.