重症肺炎伴呼吸衰竭患儿的临床治疗及VAP感染病原菌与危险因素分析  

Clinical treatment of children with severe pneumonia and respiratory failure pathogens causing VAP infection and risk factors analysis

作　　者：张云霞[1] 阮联英[1] 王征军[1] 张翠翠[1] 张高寅[1] ZHANG Yun-xia;RUAN Lian-ying;WANG Zheng-jun;ZHANG Cui-cui;ZHANG Gao-yin(Xingtai People's Hospital, Xingtai,Hebei 054000 , China)

机构地区：[1]邢台市人民医院儿科重症监护病房,河北邢台054000

出　　处：《中华医院感染学杂志》2019年第7期1102-1105,共4页Chinese Journal of Nosocomiology

基　　金：邢台市科技计划基金资助项目(2016zc290)

摘　　要：目的分析无创持续正压通气(Continuous Positive Airway Pressure,CPAP)与呼吸机持续气道正压治疗重症肺炎伴呼吸衰竭患儿的临床疗效及呼吸机相关性肺炎(Ventilator associated pneumonia,VAP)感染病原菌与危险因素。方法将2014年11月-2017年12月因重症肺炎伴呼吸衰竭疾病于医院进行治疗的130例患儿作为研究对象。将所有研究对象均分为试验组与对照组行组间对比研究,其中对照组主要采用鼻导管吸氧治疗;试验组采用无创CPAP与呼吸机持续气道正压治疗。对比两组临床疗效、VAP感染情况的差异,并分析影响VAP感染发生的主要因素。结果试验组患儿疗效优于对照组患儿(P<0.05);治疗后,两组PaO2、SaO2水平均较治疗前升高,PaCO2则较治疗前降低,且试验组改变程度优于对照组(P<0.05);Logistic回归分析结果显示:危重病例评分、机械通气时间、原发肺部疾病、头部位置、胃内容物吸入、鼻饲、受体拮抗剂使用、丙种球蛋白使用为VAP发生的主要影响因素(P<0.05);VAP感染病原菌主要以革兰阴性菌为主,共10株。结论临床中针对重症肺炎伴呼吸衰竭采用无创CPAP与呼吸机持续气道正压治疗可有效改善患儿多项临床症状,疗效显著。而针对VAP危险因素分析可为后续治疗、预防方案的制定提供数据支持。OBJECTIVE To analyze the clinical efficacy of continuous positive airway pressure (CPAP) and continuous positive airway pressure (CPAP) in the treatment of children with severe pneumonia and respiratory failure, and the pathogens and risk factors of ventilator associated pneumonia (VAP) infection. METHODS 130 children with severe pneumonia and respiratory failure treated in the hospital from Nov. 2014 to Dec. 2017 were enrolled in the study. All the subjects were divided into the observation group and the control group. The control group was treated with nasal catheter oxygen inhalation, while the observation group was treated with noninvasive CPAP and continuous positive airway pressure. The differences of clinical efficacy and VAP infection between the two groups were compared, and the main factors affecting the occurrence of VAP infection were analyzed. RESULTS The curative effect of the observation group was significantly better than that of the control group (P<0.05). After treatment ,the levels of PaO2 and SaO2 in the two groups were significantly higher than those before treatment, while PaCO2 was significantly lower than that before treatment, and the improvement of the observation group was significantly better than that of the control group (P<0.05). Logistic regression analysis showed that score of critical cases, mechanical ventilation time, primary pulmonary disease, head position, inhalation of gastric contents, nasal feeding, use of receptor antagonists and use of gamma globulin were the influencing factors for the occurrence of VAP (P<0.05). Gram-negative bacteria were the main pathogens of VAP infection, and there were 10 strains.CONCLUSION Non-invasive CPAP and continuous positive airway pressure therapy can effectively improve the clinical symptoms of children with severe pneumonia with respiratory failure, and the curative effect is significant. The analysis of risk factors for VAP can provide data support for the formulation of follow-up treatment and prevention programs.

关 键 词：无创CPAP 机械通气 重症肺炎 呼吸衰竭 VAP感染菌 

分 类 号：R563.1[医药卫生—呼吸系统]