早期气管插管的创伤患者发生呼吸机相关性肺炎的危险因素分析  

Risk factors for ventilator-associated pneumonia in early intubated trauma patients

作　　者：张晶[1] 白颖[1] 刘淙悠[1] ZHANG Jing;BAI Ying;LIU Cong-you(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院重症医学科,北京100035

出　　处：《中国医刊》2020年第4期390-393,共4页Chinese Journal of Medicine

摘　　要：目的探讨早期(入院24h以内)气管插管的创伤患者发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的危险因素。方法回顾性分析2014年1月至2018年12月于北京积水潭医院急诊首诊、入院24h内进行气管插管且机械通气大于48h的88例成人创伤患者的临床资料。根据住院期间是否发生VAP分为VAP组(42例)和无VAP组(46例),采用多因素回归分析确定早期气管插管的创伤患者发生VAP的危险因素。结果多因素回归分析显示,格拉斯哥昏迷评分法评分(OR=0.56,95%CI 0.27~0.94,P=0.031)、胸部简明损伤评分(OR=12.01,95%CI 2.66~54.28,P=0.001)和呼吸机使用时间(OR=2.24,95%CI 1.37~3.68,P=0.031)是早期气管插管的创伤患者发生VAP的独立危险因素(P<0.05)。结论早期气管插管的创伤患者是否发生VAP与多个因素有关,入院时意识水平差(格拉斯哥昏迷评分法评分低)、胸部简明损伤评分高、呼吸机使用时间长者更容易发生VAP。Objective To explore the risk factors of ventilator-associated pneumonia(VAP) in trauma patients with early tracheal intubation. Method This study included patients who were intubated within 24 hours from admitted to hospital, and lasted the intubation for more than 48 hours from Beijing Jishuitan Hospital since January 2014 to December 2018. Patient’s demographics, clinical characteristics and outcomes were compared according to presence vs absence of VAP. A total of 88 patients were enrolled in this study. VAP occurred in 42 cases(47.7%). Multivariate regression analysis was performed to identify predictors of VAP. Result Patients who developed VAP had significantly lower GCS, higher chest AIS, and higher head AIS, and longer ventilatory days than no VAP groups(P<0.05). Logistic regression analysis showed that GCS score(OR=0.56, 95% CI 0.27-0.94, P=0.031), chest AIS(OR=12.01, 95% CI 2.66-54.28, P=0.001) and ventilatory days(OR=2.24, 95% CI 1.37-3.68, P=0.031)were independent risk factors for VAP in ICU early intubated trauma patients. Conclusion The GCS, presence of chest injury and duration of ventilation play important roles in early intubated trauma patients of developing VAP.

关 键 词：呼吸机相关性肺炎 创伤 早期气管插管 机械通气 

分 类 号：R563.1[医药卫生—呼吸系统]