外科术后危重患者呼吸机相关性肺炎的危险因素分析  

Analysis on Risk Factors of Ventilator-associated Pneumonia in Critically Ill Patients after Surgery

作　　者：倪红英[1] 方强[1] 章云涛[1] 汪宵[1] 

机构地区：[1]浙江大学医学院附属第一医院

出　　处：《浙江预防医学》2008年第7期6-8,共3页Zhejiang Journal of Preventive Medicine

摘　　要：目的研究外科术后危重患者呼吸机相关性肺炎(VAP)的危险因素。方法对72例确诊有微生物感染(病例组)及66例无感染(对照组)的外科手术后呼吸机脱机困难而转入ICU的危重患者的应用单因素和多元Logistic回归分析方法,分析外科术后危重患者VAP的危险因素。结果本组患者VAP的发病率为40.0%,ICU病死率是26.6%。单因素分析提示昏迷、高位颈髓损伤、先前使用抗生素、留置胃管、再次气管插管、抑酸剂、肠外营养是VAP的危险因素;回归分析提示VAP的独立危险因素昏迷(GCS<6)、高位颈髓损伤、先前使用抗生素、留置胃管的相对危险度及95%可信区间分别为:15.422(2.546~116.20)、11.548(2.51l^58.560)、11.239(2.705~76.288)、14.336(2.106~101.389)。结论昏迷(GCS<6)、高位颈髓损伤、先前使用抗生素、留置胃管是外科术后危重患者VAP的独立危险因素。Objective To explore the risk factors of ventilator-associated pneumonia （VAP） in critically ill patients after surgery. Methods 180 critically ill patients which were shifted to ICU after surgery because of the difficulty in weaning from the respirator were retrospcetivdy analyzed. 72 patients which were diagnosed as microorganism infection were compared with 66 patients without infection. One-way variance analysis and multiple logistic regression analysis were used to assess the risk factors of VAP in critically ill patients after surgery. Results The incidence of VAP was 40%, and the mortality in ICU was 26.6%. One-way analysis indicated that coma （GCS 〈 6）, injury of superior cervical cord, previous usage of antibiotic, detaining gastric tube, tracheal intubation for the second time, antiacid and parenteral alimentafion were the risk factors of VAP. Regression analysis indicated that coma （ GCS 〈 6）, injury of superior cervical cord, previous usage of antibiotic, detaining gastric tube were the independent risk factors of VAP, the relative risks and 95% confidence intervals were 15.422 （2.546～116.20）, 11.548 （2.511～58.560）, 11.239 （2.705～76.288） and 14.336 （2.106～ 101.389）, respectively. Conclusions Coma（GCS〈6）, injury of superior cervical cord, previeus usage of antibiotic, detaining gastric tube are the independent risk factors of VAP in critically ill patients after sulgery.

关 键 词：呼吸机相关性肺炎 危重患者 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]