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纸质出版:2016
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陈晏,何海燕,杨文群,刘丁,刘蕾,曾登芬.ICU患者呼吸机相关性肺炎影响因素的回顾性分析[J].陆军军医大学学报(原第三军医大学学报),2016,38(24):2616-2620.
Chen Yan,He Haiyan,YangWenqun,Liu Ding,Liu Lei,Zeng Dengfen.Influencing factors of ventilator-associated pneumonia in ICU patients: a retrospective analysis[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(24):2616-2620.
陈晏,何海燕,杨文群,刘丁,刘蕾,曾登芬.ICU患者呼吸机相关性肺炎影响因素的回顾性分析[J].陆军军医大学学报(原第三军医大学学报),2016,38(24):2616-2620. DOI:
Chen Yan,He Haiyan,YangWenqun,Liu Ding,Liu Lei,Zeng Dengfen.Influencing factors of ventilator-associated pneumonia in ICU patients: a retrospective analysis[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(24):2616-2620. DOI:
目的 探讨ICU患者呼吸机相关性肺炎(ventilator-associated pneumonia
VAP)的影响因素,为优化预防呼吸机相关性肺炎集束化策略(ventilator care bundle
VCB)提供证据。方法 采用多因素Logistic回归分析法对我院中心ICU 2013年1-12月接受机械通气治疗的204例患者的VAP影响因素进行分析。结果 204例患者中35例发生VAP,发病率为17.16%。VAP影响因素的多因素分析结果显示:VCB未完全依从(OR=9.600,95%CI为1.060~86.935)、无持续声门下吸引(OR=9.197,95%CI为2.035~41.566)、呼吸机管理失效(OR=7.426,95%CI为1.044~52.798)、气管切开(OR=5.593,95%CI为1.420~22.031)、吸烟史(OR=4.936,95%CI为1.606~15.174)、年龄≥60岁(OR=4.334,95%CI为1.320~14.236)、肠内营养(OR=0.218,95%CI为0.061~0.779)对VAP的发生有显著影响。结论 VCB未完全依从、无持续声门下吸引、呼吸机管理失效、气管切开、吸烟史、年龄≥60岁是机械通气ICU患者的风险因素,肠内营养是保护因素。影响ICU患者VAP发病率的因素多源且复杂,应采取针对性措施,严密监控,加强集束化护理,以降低VAP的发生。
Objective To investigate the influencing factors of ventilator-associated pneumonia (VAP) in order to improve the ventilator care bundle (VCB) and decreasing the incidence of the VAP. Methods A total of 204 patients receiving mechanical ventilation at intensive care unit (ICU) in our hospital from Jan to Dec 2013 was retrospectively analyzed for studying the influencing factors of VAP using multivariable logistic regression. Results Of 204 ICU patients with the mechanical ventilation
35 had VAP with a incidence rate of 17.16%. The multivariate logistic analysis showed 7 factors influencing VAP
including the unimplemented VCB (OR=9.600
95%CI: 1.060~86.935)
absence of continuous aspiration of subglottic secretions (OR=9.197
95%CI: 2.035~41.566)
failure of ventilator management (OR=7.426
95%CI: 1.044~52.798)
tracheotomy (OR=5.593
95%CI: 1.420~22.031)
smoking(OR=4.936
95%CI: 1.606~15.174)
more than 60 years old (OR=4.334
95%CI: 1.320~14.236)
and enteral nutrition (ET) (OR=0.218
95%CI: 0.061~0.779). Conclusion Except ET is a protective factor
unimplemented VCB
absence of subglottic secretion drainage
failure of ventilator management
tracheotomy
smoking
and age over 60 are risk factors for VAP in mechanically ventilated ICU patients. Since these influencing factors are complicated and multi-sourced
it is necessary to take targeted intervention with close monitoring and strengthen the implement of VCB for reducing the incidence of VAP.
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