慢性阻塞性肺疾病急性加重期患者并发呼吸机相关性肺炎的危险因素分析  

Analysis of risk factors of AECOPD patients complicated with ventilator-associated pneumonia

作　　者：潘蔚 杜娟 栾念旭[2] PAN Wei DU Juan LUAN Nian-xu(Department of Respiratory Medicine, the Second People ＇ s Hospital of Kashi, Kashi, Xinjiang 844000, Chin)

机构地区：[1]喀什地区第二人民医院呼吸科,新疆喀什844000 [2]青岛市市立医院呼吸科,山东青岛266011

出　　处：《临床肺科杂志》2017年第1期135-137,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨慢阻肺急性加重期(AECOPD)患者并发呼吸机相关性肺炎(VAP)的危险因素,为慢阻肺急性加重期患者的临床治疗提供参考。方法回顾性分析104例慢阻肺急性加重期患者的临床资料,评价患者的一般资料(年龄、性别及体质指数)、营养支持途径(肠内营养支持及全静脉营养支持)、是否应用抑酸药、是否合并基础疾病、呼吸机通气时间等与VAP发生的关系。结果除性别外,患者年龄(≥60岁)、体质指数(≥25 kg/m2)、全静脉营养支持途径、应用抑酸药、合并基础疾病及呼吸机通气时间(≥4 d)等均可增加VAP的发生率,其VAP的发生率分别为48.61%、59.09%、64.29%、51.72%、60.00%及50.75%,组间比较差异均有统计学意义(P<0.05)。Logistic回归分析结果表明,年龄(≥60岁)、体质指数(≥25 kg/m2)、全静脉营养支持、应用抑酸药、合并基础疾病及呼吸机通气时间(≥4 h)均是影响VAP发生的独立危险因素(P<0.05)。结论慢阻肺急性加重期患者发生VAP的影响因素较多,临床治疗中应合理控制患者的体重、积极治疗基础疾病,早期进行肠内营养支持治疗,合理应用抑酸药物,缩短机械通气时间以减少VAP的发生率,改善患者的预后。Objective To study the risk factors of AECOPD patients complicated with ventilator-associated pneumonia （VAP） and to provide reference for the clinical treatment. Methods The clinical data of 104 AECOPD patients were retrospectively analyzed. The relationships of the general information （ age, gender and body mass index）, nutrition support route （enteral nutrition and total parenteral nutrition support）, the application of acid sup- pressive drugs, basic diseases, and mechanical ventilation time to the occurrence of VAP were evaluated and analyzed in this study. Results Except sex, the age of patients （aged over 60）, body mass index （ ≥25 kg/m2）, parenteral nutrition support route, application of acid suppressive drugs, underlying diseases and the time of mechanical ventilation （ ≥4 d） all could increase the incidence of VAP, with the rates of 48.61%, 59. 09%, 64. 29%, 51.72%, 60% and 50. 75%, respectively （P 〈 0. 05）. The Results of Logistic regression analysis showed that the age （over 60 years）, body mass index （ ≥25 kg/m2）, parenteral nutrition support, application of acid suppressive drugs, underlying diseases and the time of mechanical ventilation （ ≥4 d） were the independent risk factors of VAP （all P 〈 0. 05 ）. Conclusion The occurrence of VAP could be influenced by many factors in patients with AECOPD, and its incidence can be reduced by reasonable control of weight, active treatment of underlying diseases, early enteral nutrition support, reduction of the application of acid suppression drugs, and shorten the time of mechanical ventilation.

关 键 词：慢性阻塞性肺疾病 急性加重期 机械通气 呼吸机相关肺炎 影响因素 

分 类 号：R563[医药卫生—呼吸系统]