基层医院ICU呼吸机相关性肺炎的危险因素与病原学分析  

Analysis of pathogens and risk factors for ventilator-associated pneumonia in a general intensive care unit of a primary hospital

作　　者：江美嫦 陈文标[1] 关健明[1] 梁秋霞[1] 

机构地区：[1]广东省佛山市南海区第六人民医院重症监护室,佛山528248

出　　处：《广州医药》2015年第6期41-44,共4页Guangzhou Medical Journal

摘　　要：目的分析基层医院ICU VAP的危险因素及病原学情况。方法回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2%vs 31.9%,P=0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P=0.038;抗生素种类>2种:52.2%vs 26.4%,P=0.005;使用糖皮质激素:56.5%vs 27.0%,P=0.001;PPI使用>7天:65.2%vs 40.3%,P=0.008;镇静药物使用>7天:58.7%vs38.9%,P=0.035;返流:50%vs 29.2%,P=0.022;合并MODS:47.8%vs 22.2%,P=0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P=0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients（ from 2013-01 to 2014-12） under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed.Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation,MV time,types of antibiotics used,the use of hormones,the use of PPI and sedative drugs for more than 7 days,regurgitation,MODS,ICU stay time. Emergent tracheal intubation： 52. 2% vs 31. 9%,P = 0. 029; MV time： 9. 8 ± 3. 5day vs 7. 3 ±2. 8day,P = 0. 038; types of antibiotics used 〉2 kinds： 52. 2% vs 26. 4%,P = 0. 005; the use of hormones： 56. 5% vs27. 0%,P = 0. 001; the use of PPI 〉7 day： 65. 2% vs 40. 3%,P = 0. 008; the use of sedative drugs 〉7day： 58. 7% vs38. 9%,P = 0. 035; regurgitation： 50% vs 29. 2%,P = 0. 022; MODS： 47. 8% vs 22. 2%,P = 0. 004; ICU stay time：13. 6 ± 6. 6day vs 10. 2 ± 5. 3day,P = 0. 023. The use of hormones,MV time,ICU stay time were the independent risk factors of VAP [odds ratio（ OR） of multivariate logistic regression： 2. 481、1. 234、1. 075]. The main pathogens of VAP were gram-negative bacteria（ 82. 3%）. Conclusion The study shows that the use of hormones,MV time,ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs,they can be treated with anti-gram-negative bacteria antibiotics.

关 键 词：基层医院ICU 呼吸机相关性肺炎 危险因素 病原学 

分 类 号：R563.1[医药卫生—呼吸系统]