晚期早产新生儿呼吸窘迫综合征患儿机械通气治疗期间呼吸机相关性肺炎发生情况及其影响因素研究  

Incidence of and Influencing Factors of Ventilator- associated Pneumonia during Mechanical Ventilation in Late Premature Infants with Neonatal Respiratory Distress Syndrome

作　　者：张莉[1] 郑肖瑾 张耀[1] 

机构地区：[1]海南省海口市妇幼保健院新生儿科,570203

出　　处：《实用心脑肺血管病杂志》2015年第12期27-30,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：海南省卫生厅科学研究课题(琼卫2014 PT-36)

摘　　要：目的探究晚期早产新生儿呼吸窘迫综合征(NRDS)患儿机械通气治疗期间呼吸机相关性肺炎(VAP)发生情况及其影响因素。方法选择2012年3月—2015年2月在海口市妇幼保健院新生儿重症监护病房(NICU)行机械通气治疗的晚期早产NRDS患儿158例,按照VAP发生情况分为VAP组67例和非VAP组91例。收集所有患儿临床资料,包括自身因素(是否多胎、产次、胎次及有无孕期并发症、出生窒息史、出生抢救史)和医疗环境因素(呼吸机类型、机械通气时头部位置、是否重复插管上机、吸痰次数、有无大剂量使用丙种球蛋白及机械通气时间);并分析VAP病原菌分布情况。结果两组患儿是否多胎、产次、胎次及孕期并发症发生率比较,差异无统计学意义(P>0.05);VAP组患儿出生窒息史和出生抢救史所占比例高于非VAP组(P<0.05)。两组患儿呼吸机类型比较,差异无统计学意义(P>0.05);VAP组患儿机械通气时头部位置为平卧所占比例、重复插管上机率高于非VAP组,吸痰次数多于非VAP组,大剂量丙种球蛋白使用率低于非VAP组,机械通气时间长于非VAP组(P<0.05)。67例VAP患儿送检呼吸道分泌物样本共检出85株病原菌,其中革兰阴性菌64株(占75.3%)、革兰阳性菌12例(占14.1%)、真菌9株(占10.6%)。结论晚期早产NRDS患儿机械通气治疗期间发生VAP的影响因素众多,包括出生窒息史、出生抢救史、机械通气时头部位置、重复插管上机、吸痰次数、大剂量使用丙种球蛋白及机械通气时间等,应给予针对性干预并根据病原菌检测结果合理调整抗菌药物。Objective To investigate the incidence of and influencing factors of ventilator - associated pneumonia （VAP） during mechanical ventilation in late premature infants with neonatal respiratory distress syndrome （NRDS）. Methods From March 2012 to February 2015, a total of 158 late premature infants with NRDS were selected in the Department of Neonatal Intensive Care Unit, Maternity and Child Care Center of Haikou, all of them received mechanical ventilation, and they were divided into A group （complicated with VAP, n =67） and B group （did not complicated with VAP, n = 91 ） according to the incidence of VAP. Clinical data was collected to analyze the influencing factors of VAP, including polyembryony condition, parity, gravidity, incidence of pregnancy complications, birth asphyxia history, birth rescue history, breathing machine types, head position during mechanical ventilation, incidence of repeated intubation for mechanical ventilation, sputum suction times, usage of large - dose gamma ~lobulin and mechanical ventilation duration ; pathogenic bacteria distribution was analyzed. Results No statistically significant differences of incidence of polyembryony, parity, gravidity or incidence of pregnancy complications was found between the two groups （ P 〉 0. 05 ） , while the proportion of birth asphyxia history and birth rescue history of A group was statistically significantly higher than that of B group, respectively （ P 〈 0.05 ）. No statistically significant differences of breathing machine types was found between the two groups （ P 〉 0. 05 ） ; the proportion of lied low head position during mechanical ventilation and incidence of repeated intubation for mechanical ventilation of A group was statistically significantly higher than that of B group, respectively, sputum suction times of A group was statistically significantly more than that of B group, usage rate of large - dose gamma globulin of A group was statistically significantly lower than that of B group, while mechanical v

关 键 词：呼吸窘迫综合征 新生儿 通气 机械 肺炎 呼吸机相关性 晚期早产儿 影响因素分析 

分 类 号：R722.12[医药卫生—儿科]