2016—2018年湖南省某医院新生儿呼吸机相关性肺炎发病率及相关因素分析  

Analysis of incidence and risk factors of neonatal ventilator associated pneumonia in a hospital in Hunan Province,2016-2018

作　　者：周艳芳 罗家有[1] 全清华[2] 李丫妹 蒋宏[2] 付坤[2] Zhou Yanfang;Luo Jiayou;Quan Qinghua;Li Yamei;Jiang Hong;Fu Kun(Xiangya School of Public Health,Central South University,Changsha 410078,China;Department of Pediatrics,Hunan Provincial Maternal and Child Health Hospital,Changsha 410078,China)

机构地区：[1]中南大学湘雅公共卫生学院,长沙410078 [2]湖南省妇幼保健院儿科,长沙410078

出　　处：《中华预防医学杂志》2020年第8期822-827,共6页Chinese Journal of Preventive Medicine

摘　　要：目的探讨新生儿呼吸机相关性肺炎(VAP)发病率、病原菌及相关因素。方法收集湖南省妇幼保健院新生儿危重病房2016年10月至2018年6月住院并行机械通气(MV)治疗的1872例新生儿的临床病历资料进行回顾性分析,根据VAP诊断标准计算VAP发病率,并采用多因素logistic回归模型分析新生儿VAP发病的相关因素。结果VAP的发病率为8.5%(160例)。采集并送检VAP患儿标本227份,病原菌以革兰阳性菌(116份,51.1%)为主,主要为表皮葡萄球菌、粪肠球菌、鲍曼不动杆菌。多因素logistic回归分析显示,与无妊娠高血压疾病、出生时急救措施为初步复苏、MV时间≤5 d相比,母亲患妊娠高血压疾病(OR=1.93,95%CI:1.09~3.39),气管插管(OR=2.60,95%CI:1.70~3.98),MV时间为5~10 d(OR=8.10,95%CI:4.72~13.90)、11~14 d(OR=16.59,95%CI:8.63~31.90)、≥15 d(OR=25.69,95%CI:13.77~47.92)是VAP发病的相关因素。结论新生儿MV持续治疗者VAP的发病率较高,病原菌以革兰阳性菌为主,且VAP与母亲患妊娠高血压疾病、气管插管、MV时间等因素有关。Objective To investigate the incidence and risk factors of ventilator-associated pneumonia(VAP)in neonatal intensive care unit(NICU),and to provide evidence for the prevention and control of VAP.Methods A total of 1872 neonates,who were admitted into NICU of Hunan Provincial Maternal and Child Health Hospital and subjected to mechanical ventilation from October 2016 to June 2018,were enrolled in the study.The neonates who met the diagnostic criteria of VAP were selected as the case group,and those who were treated with ventilator for 48 hours at the same time were regarded as the control group.Multivariate logistic regression model was used to analyze the related factors of VAP.Results Of the 1872 neonates who underwent the mechanical ventilation,the VAP occurred in 160 cases with the incidence rate of 8.5%(160 cases).The 227 specimens were collected.Gram-positive bacteria(n=116,51.1%)were the main pathogens.The main pathogens were Staphylococcus epidermidis,Enterococcus faecalis,Acinetobacter baumannii.By Chi-square test,birth weight,birth age,Apgar score,duration of ventilator,and whether newborn mothers with pregnancy hypertension were influencing factors.The result of logistic regression analysis showed that compared with no pregnancy included hypertension,the first aid measure at birth was initial resuscitation,and the MV time≤5 days,the risk factors of ventilator-associated pneumonia in neonates included:their mothers with hypertensive disorders complicating pregnancy,using of tracheal intubation and ventilator time more than 5 days.Conclusion The incidence of VAP in neonates receiving continuous MV therapy in neonatal intensive care unit is higher.Gram-positive bacteria are the main pathogens.VAP in neonates is related to whether newborn mothers with pregnancy hypertension,MV duration and tracheal intubation.

关 键 词：新生儿学 肺炎 呼吸机相关性 病原菌 横断面研究 

分 类 号：R722.135[医药卫生—儿科]