呼吸机相关肺炎发病率及危险因素前瞻性研究
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黄妮妮

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R181.3+2

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Prospective study on the incidence and risk factors of ventilatorassociated pneumonia
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    摘要:

    目的了解呼吸机相关肺炎(VAP)发病率及其危险因素,为预防VAP提供依据。 方法对 2006年1月—2011年12月2所三级甲等综合医院使用呼吸机患者开展VAP前瞻性监测,选取发生VAP医院感染患者作为VAP组,未发生VAP医院感染患者作为非VAP组(1∶1配比),进行危险因素分析。结果共监测使用呼吸机患者2 550 例,发生VAP 475例,机械通气总日数32 623 d,VAP发病率为14.56‰。单因素分析表明:反复呼吸道感染病史、1个月内使用广谱抗菌药物、多次住院、昏迷、低蛋白血症、脱机失败后再次插管、使用糖皮质激素、机械通气>5 d、误吸、口腔卫生情况差是VAP发生的危险因素。多因素logistic 回归分析显示,昏迷(OR 95% CI:1.38~2.93)、低蛋白血症(OR 95% CI:1.12~2.10)、使用糖皮质激素(OR 95% CI:1.10~2.24)、脱机失败再次插管(OR 95% CI:2.14~4.74)、机械通气>5 d(OR 95% CI:2.55~4.83)、误吸(OR 95% CI:1.24~2.77)、口腔卫生情况差(OR 95% CI:1.72~3.74)是VAP发生的独立危险因素。结论VAP发病率较高,其危险因素众多,应采取正确的口腔清洁、抬高头位、及时评估撤机、改善营养状况等综合干预措施,降低VAP的发病率。

    Abstract:

    ObjectiveTo study the incidences and risk factors of ventilatorassociated pneumonia (VAP),and provide basis for prevention and control of VAP. MethodsPatients who used ventilators in two tertiary firstclass general hospitals from January 2006 to December 2011 were performed prospective monitoring; patients with VAP were  selected as VAP group, and without VAP were in nonVAP group (1∶1 ratio), risk factors for VAP were analyzed. ResultsA total of 2 550 patients who used ventilators were monitored, 475 cases of VAP occurred, the total number of ventilation days were 32 623, incidence rate of VAP was 14.56‰. Univariate analysis showed that risk factors for VAP were history of recurrent respiratory tract infection, use of broad spectrum antimicrobial agents within one month, multiple hospitalization, coma, hypoproteinemia, intubation again after failure in ventilator weaning, use of glucocorticoid, mechanical ventilation for >5 days, regurgitation, and poor oral hygiene. Multivariate logistic regression analysis showed that independent risk factors for the occurrence of VAP were  coma (OR 95% CI:1.38-2.93), hypoproteinemia (OR 95% CI:1.12-2.10), use of glucocorticoid (OR 95% CI:1.10-2.24), intubation again after failure in ventilator weaning (OR 95% CI:2.14-4.74), mechanical ventilation>5 days (OR 95% CI:2.55-4.83), regurgitation (OR 95% CI:1.24-2.77), and poor oral hygiene (OR 95% CI:1.72-3.74). ConclusionIncidence of VAP is high, and risk factors are multiple, comprehensive intervention measures (proper oral hygiene, headofbed elevation, timely assessment of withdrawal of respirator, and improving nutritional status) should be taken, so as to reduce the incidence of VAP.

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黄妮妮,胡美春,韦思尊,等.呼吸机相关肺炎发病率及危险因素前瞻性研究[J]. 中国感染控制杂志,2016,15(11):845-848. DOI:10.3969/j. issn.1671-9638.2016.11.010.
HUANG Nini, HU Meichun, WEI Sizun, et al. Prospective study on the incidence and risk factors of ventilatorassociated pneumonia[J]. Chin J Infect Control, 2016,15(11):845-848. DOI:10.3969/j. issn.1671-9638.2016.11.010.

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  • 在线发布日期: 2016-11-30
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