综合ICU呼吸机相关性肺炎的危险因素调查  

Analysis of risk factors for ventilator-associated pneumonia in comprehensive ICU and nursing strategy

作　　者：戚少云[1] 马兴好[1] 刘正东[2] 李玲[2] 

机构地区：[1]安徽医科大学附属六安医院医院感染管理办公室,237005 [2]安徽医科大学附属六安医院ICU病房,237005

出　　处：《中华现代护理杂志》2013年第21期2531-2533,共3页Chinese Journal of Modern Nursing

摘　　要：目的 探讨综合重症监护病房（ICU）呼吸机相关性肺炎（VAP）的危险因素,为预防控制VAP提供理论参考.方法 对某三级医院综合ICU 2011年1-12月所有持续机械通气时间≥48 h的患者进行监测,记录患者的临床流行病学特点和诊疗操作情况,应用多元Logistic回归方法分析VAP的危险因素.结果 共收集病例168例,其中VAP 60例,VAP的发生率为35.7％；单因素分析显示,胃肠内营养、机械通气类型、气管切开、合并其他部位感染、抗生素使用数量、呼吸机使用时间、总住院天数和ICU住院天数是VAP的重要危险因素；多因素Logistic回归分析显示,机械通气类型（OR=10.945,P＜0.05）、抗生素使用数量（OR=1.653,P＜0.01）和ICU住院天数（OR=1.111,P＜0.01）是VAP的独立危险因素.结论 ICU患者是发生VAP的高危人群且危险因素较多,应采取针对性的措施,如尽量缩短机械通气的时间和ICU的住院时间、避免频繁更换抗生素、减少有创操作等,预防VAP的发生.Objective To investigate the risk factors and nursing strategy of ventilator-associated pneumonia （VAP） in intensive care unit （ICU）,and provide reference for preventing and controlling VAP.Methods Totals of 168 cases with mechanical ventilation （MV） duration over 48 hours in ICU from Jan 2011 to Dec 2011 were studied.The clinical epidemiological characteristics and treatment process were recorded.The risk factors of VAP were analyzed by Logistic regression.Results Totally 60 VAP cases among 168 patients were collected,the incidence of VAP was 35.7％.The univariate analysis showed that enteral nutrition,mechanical ventilation type,tracheotomy,infections at other sites,the number of antibiotics,ventilator time and total hospital days and ICU days were important risk factors of VAP.Logistic regression analysis showed that mechanical ventilation type （OR =10.945,P ＜0.05）,the number of antibiotics （OR =1.653,P ＜0.01） and ICU hospital days （OR =1.111,P ＜ 0.01） were independently associated with VAP.Conclusions Because of many risks factors,the patients in ICU are the high risk group of VAP.Specific measures should be taken to prevent the incidence of VAP,such as：reducing the duration of mechanical ventilation,ICU length of stay and invasive treatment Etc.

关 键 词：重症监护病房 肺炎 呼吸机相关性 危险因素 LOGISTIC回归分析 

分 类 号：R563[医药卫生—呼吸系统]