重型颅脑损伤后呼吸机相关性肺炎的危险因素分析  

Risk factors analysis of ventilator-associated pneumonia in severe brain injury patients

作　　者：郭文龙[1] 周源[1] 王双琴[1] 聂伟[1] 蒋启鑫[1] 卿晨[1] 

机构地区：[1]湖南中医药高等专科学校附属第一医院ICU,湖南株洲412000

出　　处：《中国现代医学杂志》2013年第24期90-92,共3页China Journal of Modern Medicine

摘　　要：目的分析重型颅脑损伤患者呼吸机相关性肺炎（SBI—vAP）的危险因素。方法回顾2007～2011年本院收治的重型颅脑损伤并行机械通气≥48h的患者137例，按照发生和未发生VAP将患者分成两组。记录两组患者性别、年龄、基础疾病[慢性阻塞性肺疾病（COPD）、糖尿病、心力衰竭、休克]、肺外感染、气管切开、误吸、Glasgow昏评分、是否手术，先行单因素分析筛选出若干变量进行多因素二分类Logistic回归分析。结果发生vAP患者52例，发生率为37．9％。多因素Logisfic回归分析显示SBI—vAP独立危险因素有术前存在慢性阻塞性肺疾病（COPD）、糖尿病、肺外感染、误吸、气管切开和Glasgow昏迷评分≤9分。发生VAP患者死亡24例，死亡率为46．2％，与未发生vAP患者死亡18，死亡率为21．2％。结论重型颅脑损伤患者呼吸相关性肺炎的危险因素为慢性阻塞性肺疾病（COPD）、糖尿病、肺外感染、误吸、气管切开和Glasgow昏迷评分≤9分。[Objective] To observe the risk factors for ventilator-associated pneumonia （VAP） in severe brain in- jury （SBI） patients. [Methods ] Retrospective 137 cases in our ICU from 2007-2011 and required mechanical venti- lation longer than 48 h were recorded the risk factors. The cases were divided into VAP group and No-VAP group according to whether the patient combined with VAP. The gender, age, basic diseases [chronic obstructive pulmonary disease（COPD）, diabetes, heart failure, shock], pulmonary infection, tracheostomy, aspiration, Glasgow score, whether surgery or not were reported and all data was first ANOVN to select risk factors then performed multivariate factors logistic regression analysis. [ Results ] The risk factors for SBI-VAP were COPD, diabetes, infection other than pul- monary, aspiration, tracheotomy, Glasgow coma score ≤ 9.24 cases in VAP group died, the mortality rate was 46.2% and 18 cases in No-VAP group died, the mortality rate was 37.9%. [ Conclusions ] The risk factors of respiratory- related pneumonia in severe traumatic brain injury patients were chronic obstructive pulmonary disease（COPD）, dia- betes, pulmonary infection, aspiration, tracheotomy, and Glasgow scores ≤ 9.

关 键 词：呼吸机相关性肺炎 危险因素 重型颅脑损伤. 

分 类 号：R563.1[医药卫生—呼吸系统]