老年呼吸机相关性肺炎病原菌分布及危险因素分析  

Analysis on pathogenic bacteria distribution and risk factors of ventilator associated pneumonia in elderly patients

作　　者：吕雪[1] 

机构地区：[1]海南省人民医院龙华门诊部急诊ICU,海口570102

出　　处：《山西医药杂志》2015年第21期2482-2484,共3页Shanxi Medical Journal

摘　　要：目的探讨老年呼吸机相关性肺炎(VAP)病原菌分布及其发病的相关危险因素,为早期防治VAP提供依据。方法将机械通气≥48h的197例患者,依据是否发生VAP分为VAP组和非VAP组,分析VAP病原菌分布,采用多因素Logistic回归分析影响VAP发病的危险因素。结果老年机械通气患者的VAP发病率为31.5%(62/197);VAP病原菌分布:革兰阴性菌占54.4%、革兰阳性菌占31.2%、真菌占14.5%;多因素分析结果显示:基础疾病(OR=2.746)、侵入性操作(OR=5.720)、机械通气(OR=3.740)、长期使用抗菌药物(OR=3.927)、长期使用糖皮质激素(OR=4.646)、使用抑酸制剂(OR=2.570)、急性生理与慢性健康评分(APACHE)Ⅱ(OR=1.809)均为VAP发病的危险因素。结论老年机械通气患者具有很高的VAP发病率,以革兰阴性菌为主,基础疾病多、有侵入性操作、长期使用抗生素和糖皮质激素、使用抑酸制剂、低蛋白血症、APACHEⅡ评分高均为VAP发病的独立危险因素。Objective To explore pathogenic bacteria distribution and risk factors of ventilator associated pneumonia（VAP）in elderly patients,and to provide basis for early preventing and intervening for VAP.Methods One hundred and ninty-seven cases of elderly patients with mechanical ventilation over 48 hwere divided into VAP group and non-VAP group.Pathogenic bacteria distribution of VAP was analyzed,and the risk factors of VAP were screened by multiple factors logistic regression analysis methods.Results VAP incidence rate of elderly patients with mechanical ventilation was 31.5%（62/197）.VAP pathogenic bacteria distribution was respectively G-54.4%,G＋31.2% and fungus 14.5%.Multiple factors analysis result showed that the risk factors of VAP included grounding disease（OR=2.746）,penetration operation（OR=5.720）,mechanical ventilation（OR=3.740）,long-term use of antibiotics（OR=3.927）and glucocorticoid（OR=4.646）,use of antacid preparation（OR=2.570）and APACHEⅡ score（OR=1.809）.Conclusion The elderly patients with mechanical ventilation showed a higher incidence rate of VAP,mainly in Gram-negative bacteria.These factors such as grounding disease,penetration operation,long-term use of antibiotics and glucocorticoid,and nigh APACHEⅡscore were independent risk factors of VAP.

关 键 词：呼吸机相关性肺炎 病原菌 危险因素 老年患者 

分 类 号：R563.1[医药卫生—呼吸系统]