新生儿重症监护室新生儿呼吸机相关肺炎的高危因素分析  

Risk factors of ventilator associated pneumonia in neonatal intensive care unit

作　　者：李丽[1] LI Li(Neonatal Department,Luoyang Women and Children Medical Care Center,Luoyang,Henan 471000,China)

机构地区：[1]洛阳市妇女儿童医疗保健中心新生儿科,河南洛阳471000

出　　处：《临床肺科杂志》2018年第4期736-738,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探究新生儿重症监护室新生儿呼吸机相关肺炎(VAP)的高危因素。方法对通气时间≥48h的80例新生儿的临床资料进行回顾性分析。其中40例VAP患儿纳入观察组,其余40例未发生VAP患儿纳入对照组,对胎龄、通气时间、出生体重等可能的危险因素进行单因素分析,并通过Logistic回归分析进行多因素分析。结果单因素分析结果显示,两组胎龄、出生体重、通气时间、气管内吸引、合并败血症和再插管情况相比,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,胎龄、通气时间、气管内吸引和再插管是新生儿重症监护室VAP发生的独立性危险因素(P<0.05)。40例VAP患儿痰培养阳性率为77.5%(31/40),共分离出46株病原菌。其中,革兰阴性菌占71.7%(33/46),包括肺炎克雷伯杆菌19株(41.3%),鲍曼不动杆菌10株(21.7%),大肠杆菌4株(8.7%);革兰阳性菌占28.3%(13/46),溶血性链球菌6株(13.0%),表皮葡萄球菌3株(6.5%),金黄色葡萄球菌4株(8.7%)。结论新生儿重症监护室VAP发生率较高,通气时间过长、吸痰操作次数过多、再插管等,都是其重要的危险因素,革兰阴性菌是主要致病菌,临床操作应严格遵循无菌原则以避免VAP发生。Objective To explore the risk factors of ventilator associated pneumonia in neonatal intensive care unit(ICU).Methods The clinical data of 80 newborns received≥48h ventilation were retrospectively analyzed.40 of them with ventilator-associated pneumonia were taken as the observation group,and the remaining 40 cases without ventilator-associated pneumonia in the control group.Their gestational age,birth weight,ventilation time and other possible factors were given single factor analysis and multivariate analysis by logistic regression analysis.Results The single factor analysis showed that there was significant difference between the two groups in terms of gestational age,birth weight,ventilation time,intra tracheal aspiration,sepsis and re-intubation(P<0.05).The results of multivariate logistic regression analysis showed that gestational age,ventilation time,aspiration and re-intubation were independent risk factors for VAP in neonatal intensive care unit(P<0.05).In 40 children with VAP,the positive rate of sputum culture was 77.5%(31/40),and 46 strains of pathogenic bacteria were isolated.Among them,gram negative bacteria accounted for 71.7%(33/46),including 19 strains of Klebsiella pneumoniae(41.3%),10 strains of Bauman Acinetobacter(21.7%),and 4 strains of Escherichia coli(8.7%).Gram positive bacteria accounted for 28.3%(13/46),including 6 strains of Streptococcus hemolyticus(13%),3 strains of Staphylococcus epidermidis(6.5%),and 4 strains of Staphylococcus aureus(8.7%).Conclusion The incidence of VAP is high in neonatal ICU,and the risk factors include long duration of ventilation,excessive phlegm,suction operation times and intubation.Gram negative bacteria are the main pathogens,and clinical operation should be strictly followed by the principle of sterile to avoid the occurrence of VAP.

关 键 词：呼吸机相关肺炎 高危因素 新生儿 

分 类 号：R722.135[医药卫生—儿科]