早产儿呼吸机相关性肺炎高危因素分析  

High risk factors analysis of ventilator-associated pneumonia in premature

作　　者：陈华友[1] 徐乃军[2] 

机构地区：[1]四川自贡市第一人民医院儿科,四川自贡643000 [2]吉林大学第一医院二部儿科,长春130000

出　　处：《中国实用儿科杂志》2009年第7期542-544,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨早产儿呼吸机相关性肺炎(VAP)的高危因素。方法对2007年3月至2008年3月在吉林大学第一附属医院新生儿科住院的通气时间≥48h的99例早产儿的病历资料进行回顾性分析。将99例早产儿分为两组:发生VAP的64例为VAP组,未发生VAP的35例为对照组。以胎龄、出生体重、通气时间等19个因素为预想危险因素进行单因素及多因素分析,总结各危险因素与VAP的相关性。结果早产儿VAP的发生率为64.6%,病死率为21.9%。早产儿VAP的多因素逐步Logistic回归分析显示,各危险因素在发生VAP中的作用大小顺序依次为:再插管、机械通气时间、气管内吸引、胎龄、原发病、贫血、使用中枢抑制剂;预防性静脉应用丙种球蛋白(IVIG)为预防发生VAP的保护性因素。结论早产儿VAP发生率及病死率高,高危因素众多,是外部环境与患儿内环境综合作用的结果,采取综合防治措施可能是控制VAP的最佳策略。Objective To explore high risk factors of VAP in premature. Methods A retrospective study was conducted in 99 patients who had the hours of mechanical ventilation≥ 48h. Among the patients, mechanical ventilated prematures who suffered VAP were included in a observation group, and non-VAP prematures were in a control group. Case-control method, single-fastor analysis with Chi-square test and muhiple logistic regression were performed to determine risk factors such as gender, gestation age, birth weight, ventilation hour, and so on. Results There were 64 episodes of VAP in 99 patients who were mechanically ventilated more than 48 hours. The incidence of VAP was 64.6%. By multiple logistic regression analysis, reintuba-tion, duration of mechanical ventilation, airway suctioning, gestation age , primary lung disease, anaemia, treatment with CNS suppressant independently predicted neonatal VAP . Use of IVIG was a protection factor in preventing VAP. Conclusion Incidence and mortality of VAP in prematures are high, with many high risk factors, which is the result of comprehensive action of external environment and internal environment of prematures. A comprehensive prevention and treatment may be the best way to manage VAP.

关 键 词：早产儿 呼吸机相关性肺炎 高危因素 

分 类 号：R72[医药卫生—儿科]