脑卒中患者行机械通气继发呼吸机相关性肺炎的影响性研究

目的探讨脑卒中患者机械通气各项影响因素与继发呼吸机相关性肺炎(Ventilator associated Pneumonia,VAP)的影响性。方法回顾性、连续性纳入2014年7月1日-2015年11月1日期间我院重症监护室所收治脑卒中接受机械通气患者的临床资料。纳入患者的一般情况如性别、年龄、体重指数、既往史。登记本次入院期间的插管方式、鼻饲管选择、鼻饲方式、预防应激性溃疡的用药种类、并发症情况、各种分泌物护理情况、气道湿化情况、排痰情况、更换各种呼吸机配件情况、抬高床头角度、院感规避风险、探视情况、是否气管切开等各项细节。以所纳入患者是否继发VAP为因变量,上述登记的各项潜在影响因素为自变量,采用单因素和多因素logistic回归分析研究患者继发VAP的独立影响因素。结果经纳入、排除标准,共纳入96例患脑卒中的手术患者,其中出血性脑卒中17例、缺血性脑卒中79例。累计36例患者于入院一周内继发VAP、60例患者未继发VAP。最终Logistic回归分析结果显示:其中泵注法鼻饲、雾化湿化、定时吸痰、抬高床头为独立保护因素(P0.05);GCS评分、合并神经源性肺水肿、并发胃内容物反流、机械通气时间为独立危险因素(P0.05)。结论影响VAP的发生因素众多,而脑卒中患者的特殊情况又加重了VAP的发病风险,需要全方位、多层次干预。在临床工作中予以充分注重本研究已探明的影响因素,从而切实有效降低VAP的发生。

Impact of various factors between mechanical ventilation with ventilator associated pneumonia in cerebral stroke patients

Objective To investigate the impact of various factors between mechanical ventilation with venti-lator associated pneumonia (VAP)in cerebral stroke patients.Methods The clinical data of cerebral stroke from 1st July,2014 to 1st November,2015 in our hospital with mechanical ventilation were retrospectively analyzed.The entry included the general situation of the patients such as sex,age,body mass index,and disease history.It also re-corded their cannula way during the feeding tube selection,nasal way,the type of stress ulcer prevention medication, complications,various secretions care situations,airway humidification,the expectoration,the replacement of various breathing machine accessories,the elevation angle of the bed,hospital infection risk aversion,visitation case,wheth-er tracheotomy and other details.Whether patients with the inclusion of secondary VAP were taken as the dependent variable,the potential impact of the above factors registered as independent variables,it used univariate and multiva-riate logistic regression analysis to analyze the independent factors.Results After inclusion and exclusion criteria, 96 patients were included in this study,included 17 cases of hemorrhagic stroke and 79 cases of ischemic stroke.The secondary VAP occurred in 36 patients within a week,and 60 cases without secondary VAP.Final logistic regression analysis showed the independent protective factors included nasogastric infusion method,wet fog,timing of suction and raising the bed (P <0.05),and the independent risk factors included GCS score,merge neurogenic pulmonary edema,complicated with reflux of gastric contents flow,and mechanical ventilation time (P <0.05).Conclusion Many factors influence the occurrence of VAP,and the special circumstances of stroke patients has increased the risk of VAP,which needs all-round,multi-level intervention.The risk factors proven in this study should be paid more at-tention in clinical work to reduce the incidence of VAP.