呼吸机相关性肺炎血流感染相关因素分析  

Analysis of factors related to bloodstream infection of ventilator-associated pneumonia

作　　者：谢朝云 熊芸 李耀福 蒙桂鸾 杨怀[2] XIE Chaoyun;XIONG Yun;LI Yaofu;MENG Guiluan;YANG Huai(Department of Infection Management,the Third Affiliated Hospital of Guizhou Medical University,Duyun 558000,China;Department of Infection Management,Guizhou Provincial People′s Hospital)

机构地区：[1]贵州医科大学第三附属医院感染管理科,贵州都匀558000 [2]贵州省人民医院感染管理科

出　　处：《西北国防医学杂志》2021年第3期167-172,共6页Medical Journal of National Defending Forces in Northwest China

基　　金：贵州省科技厅联合项目[黔科合LH字(2014)7162号];贵州省黔南州社会发展科技项目[黔南科合社字(2018)7号]。

摘　　要：目的:分析呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者血流感染相关因素。方法:回顾性分析2012-04-01~2019-02-01我院收治的726例VAP患者的临床资料,对其发生血流感染的相关因素进行单因素和多因素Logistic回归分析,以确定发生VAP血流感染的相关因素。结果:VAP血流感染发生率为29.67%。单因素回归分析显示,年龄(≥60岁)、慢性心肺基础疾病史、糖尿病史、迟发型VAP、入住ICU、APACHEⅡ评分≥15、机械通气时间(≥7 d)、使用糖皮质激素、血糖(>11.1 mmol/L)、血清白蛋白(<30 g/L)、C反应蛋白(>10 mg/L)、降钙素原(>2 ng/ml)等均是VAP血流感染的危险因素(P<0.05)。多因素分析结果显示,APACHEⅡ评分≥15、降钙素原(>2 ng/ml)、使用糖皮质激素、血糖(>11.1 mmol/L)、机械通气时间(≥7 d)为VAP血流感染的独立危险因素。结论:VAP血流感染相关因素较多,应重点关注病情严重患者、减少不必要使用糖皮质激素、控制血糖、及时评估是减少VAP血流感染的主要措施,降钙素原监测可早期发现VAP血流感染。Objective:To analyze the related factors of bloodstream infection in patients with ventilator-associated pneumonia(VAP).Methods:The clinical data of 726 patients with VAP from April 2012 to February 2019 were reviewed.The factors related to VAP bloodstream infection were analyzed by univariate analysis and multivariate Logistic analysis,and to determine the factors related to VAP bloodstream infection.Results:The VAP bloodstream infection rate was 29.67%.Univariate regression analysis showed that age(≥60 years),chronic cardiopulmonary disease history,diabetes history,delayed VAP,admission to ICU,APACHEⅡscore≥15,mechanical ventilation time(≥7 d),glucocorticoids,blood glucose(>11.1 mmol/L),serum albumin(<30 g/L),C-reactive protein(>10 mg/L),and procalcitonin(>2 ng/ml)were risk factors for VAP bloodstream infection(P<0.05).Multivariate analysis showed APACHEⅡscore≥15,procalcitonin(>2 ng/ml),use of glucocorticoids,blood glucose(>11.1 mmol/L),mechanical ventilation time(≥7 d)were independent risk factors related to bloodstream infection in patients with VAP.Conclusion:Focusing on patients with serious illness,reducing unnecessary use of glucocorticoids,controlling blood sugar,and timely assessment are the main measures to reduce bloodstream infection of VAP.The serum level of procalcitorin may be helpful to predict bloodstream infection in patients with VAP.

关 键 词：呼吸机相关性肺炎 血流感染 相关因素 LOGISTIC回归分析 

分 类 号：R563.1[医药卫生—呼吸系统]