通气相关肺炎致病危险因素的巢式病例对照研究  

Risk factors of ventilation associated pneumonia:A nested case control study

作　　者：代芊[1] 薛国文[1] 刘建平[1] 张蔚[1] 王思雄[1] 

机构地区：[1]第三军医大学预防医学系流行病学教研室

出　　处：《第三军医大学学报》1998年第6期488-491,共4页Journal of Third Military Medical University

基　　金：全军"九五"攻关项目

摘　　要：目的：探讨通气相关肺炎（ＶＡＰ）的致病危险因素。方法：采用巢式病例对照研究的方法，对５８例确诊为ＶＡＰ的病例，按同科室，同性别，年龄相同或相近（±５岁），入院时间相同或相近（＜１周），病情相似，１∶１配以５８例对照，进行单因素、剂量效应和多因素Ｌｏｇｉｓｔｉｃ回归分析。结果：①单因素分析，有１６种差异呈显著性。②多因素条件性Ｌｏｇｉｓｔｉｃ回归分析表明：基础病病情重（ＯＲ＝９．４０）、留置胃管（ＯＲ＝８．８６）、患者意识状态差（ＯＲ＝８．３９）、气管切开（或插管）时间长（＞２周）（ＯＲ＝６．８９）、有颅脑外伤（ＯＲ＝６．６０）、频繁更换呼吸机接头插管（ＯＲ＝６．４４）、应激性溃疡预防用药（ＯＲ＝５．５２）、住院时间长（＞１月）（ＯＲ＝４．３１）为ＶＡＰ发生的独立危险因素。基础病病情程度、气管切开或插管时间、住院时间、患者意识状态程度与ＶＡＰ的发生存在明显量效关系。③用美蓝经胃管注入体内，随后２ｄ在咽部及下呼吸道分泌物中检出，证明存在胃→咽→下呼吸道的逆行感染途径。结论：ＶＡＰ的发生是多因素的综合，既有外源性的，也有内源性的。Objective: To investigate the risk factors of ventilation associated nosocomial infected pueumonia. Methods:Nested case control study was used. The test group consisted of 58 cases of nosocomial pneumonia and the control group also of 58 cases. Each of the patients of the tested group was coupled with one from the control group. The 2 patients of each pair suffered from the same primary disease from the same department, were of the same sex, similar to each other in their age (±5 years) and in there hospitalizathio time (difference were less than 1 week). But the cases of the control did not suffered from nosocomial pneumonia . Single factor analysis, dosage effect analysis and multiple factor Logistic regression analysis were done for all the patients. Results: After analyzing more than 20 factors, it was found that the difference of only 15 factors was of statistical significanc. The results of a multiple stepwise Logistic regression showed: ① the serious of primary disease(OR=9.40),②use of nasogastric tubes(OR=8.86),③conciousness(OR=8.39),④mechanical ventilation using(OR=6.89),⑤ trauma of brain(OR=6.60),⑥frequent changing of the ventilator equipmant (OR=6.44),⑦stress ulcer prophylaxis(OR=5.52),⑧long hospitalization(OR=4.31). Being perfused into the body through nasogastric tubes, Methylene blue were found in the secretion of the throat and the lower respiratory tract after two days, which suggested that there existed retrograde infection from the stomach to the throat and to the lower respiratory tract. Conclusion:The development of ventilation associated pneumonia results from many rish factors including exogenous and endogenous ones. The retrograde infection from the stomach is one of the most important.

关 键 词：通气相关肺炎 危险因素 肺炎 Logistic回归法 

分 类 号：R563.102[医药卫生—呼吸系统]