地区医院ICU呼吸机相关肺炎及死亡高危因素及病原菌分析  

Risk factors and pathogens for the occurrence of ventilatorassociated pneumonia and mortality in a local hospital

作　　者：蒋朝阳[1] 常健源[1] 段振兴[1] 杨征波[1] 何富刚[1] 张展[1] 张先[1] 

机构地区：[1]湖南怀化市第一人民医院重症医学科,湖南怀化418000

出　　处：《中国现代医学杂志》2014年第18期80-84,共5页China Journal of Modern Medicine

摘　　要：目的研究湖南怀化市第一人民医院ICU呼吸机相关肺炎（VAP）、死亡高危因素及病原菌检测,为制定这些患者的治疗计划提供依据。方法统计该院2009年6月-2013年3月ICU使用机械通气治疗328例患者的临床资料。筛选出VAP及死亡易感因素,并检验其相关性。结果接受机械通气的328例患者中有49例VAP,其中死亡22例,死亡率为44.9%,明显高于非VAP患者28.7%的死亡率。充血性心力衰竭、糖皮质激素治疗、Pao2/Fio2、APACHE II评分、急性肾功能衰竭及菌血症与VAP发生具有相关性。高龄、高APACHE II评分、低Pao2/Fio2比,易患菌血症,免疫抑制状态,急性肾衰及充血性心力衰竭等原因与死亡相关。多因素分析显示,鼻胃管留置（95%CI,1.78-4.66）、气管切开（95%CI,3.91-11.50）及抑酸剂（95%CI,1.19-6.64）是发生VAP的独立危险因素（均P〈0.01）。绿脓杆菌和鲍氏不动杆菌是所有VAP感染患者呼吸道分离培养最常见的革兰阴性菌,金黄色葡萄球菌是所有VAP感染患者呼吸道分离培养最常见的革兰阳性菌。在VAP死亡患者中,感染金葡菌及曲霉菌更常见,与存活者相比,差异有显著性。结论 ICU医生应了解呼吸机相关肺炎（VAP）及死亡患者这些危险因素,将有利于这类患者治疗计划的制定。【Objective】To determine the risk factors for VAP and the influence of VAP on patient in the local institution, and provide the basis for the treatment plans for these patients.【Methods】From Jun 2009 to Mar. 2013,328 patients who required mechanical ventilation for longer than 24 hours were screened VAP and the relevance mortality risk factors were examined. 【Results】Of all the patients, VAP occurred in 49 patients（14.9%） receiving mechanical ventilation and 22 cases died. The death rate was 44.9%, while that of non-VAP was 28.7%. The mortality of patients with VAP was significantly greater than that of patients without VAP. Congestive heart failure, corticosteroid therapy, Pao2/Fio2, APACHE II score, acute renal failure, and bacteremia were correlated with the incidence of VAP. Age, high APACHE II score, low Pao2/Fio2ratio, susceptibility to bacteremia, immunosuppression, acute renal failure and congestive heart failure and other reasons were also associated with death. Logistic regression analysis demonstrated that reintubation（AOR, 2.88; 95% CI, 1.78 to 4.66; P〈0.001）, tracheostomy（adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 3.91 to 11.50; P〈0.001）, and the use of antacids（AOR, 2.81; 95% CI,1.19 to 6.64; P =0.019） were independently associated with the development of VAP. Pseudomonas aeruginosa and acinetobacter baumannii were the most common Gram-negative bacterial pathogens isolated from the respiratory tract among infected patients with VAP for all patients. Staphylococcus aureus was the most common Gram-positive bacterial pathogen associated with VAP. S aureus and Aspergillus spp were significantly more common among patients with VAP who died.【Conclusions】These data suggest that VAP is a common nosocomial infection in a local hospital. ICU clinicians should be aware of the risk factors for VAP, which could be useful in identifying patients at high risk for VAP and modifying patient care to minimize the risk of VAP. And it will help to develop the local

关 键 词：重症监护病房(ICU) 住院死亡率 院内感染 危险因子 

分 类 号：R563.1[医药卫生—呼吸系统]