机械通气新生儿发生呼吸机相关性肺炎影响因素分析  

Influencing factors of ventilator-associated pneumonia in neonates with the treament of mechanical ventilation

作　　者：杨婷婷 王军 Yang Tingting;Wang Jun(Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Pediatrics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学,221000 [2]徐州医科大学附属医院儿科,221000

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第2期234-239,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：江苏省妇幼健康科研项目(F201850)。

摘　　要：目的探讨机械通气(MV)新生儿发生呼吸机相关性肺炎(VAP)影响因素。方法选择2018年6月至2021年5月,于徐州医科大学附属医院新生儿重症监护病房(NICU)住院治疗的68例MV新生儿为研究对象。采用回顾性研究方法,根据MV治疗48 h后是否并发VAP,将其分别纳入研究组(n=15)与对照组(n=53)。对2组患儿性别、出生胎龄、日龄、出生体重、分娩方式、是否为早产儿、有无原发性肺疾病、Apgar评分、MV治疗时间、胃内容物反流,营养不良,血清白蛋白、白细胞介素(IL)-6与-8水平等,以及VAP新生儿病原菌分布情况,采用成组t检验与χ^(2)检验进行统计学比较。对MV新生儿发生VAP的影响因素进行多因素非条件logistic回归分析。2组新生儿性别构成比、日龄、出生体重等一般临床资料比较,差异均无统计学意义(P>0.05)。本研究经过病例收集医院医学伦理委员会批准(审批文号:KY2021010)。结果①MV新生儿VAP发生率为22.1%(15/68)。采集研究组15例发生VAP新生儿支气管分泌物,共培养出16株致病菌株中,14株(87.50%)为革兰阴性菌,其中肺炎克雷伯杆菌、大肠埃希菌占比较高,分别为50.00%(8/16)、18.75%(3/16)。②研究组患儿MV治疗时间与合并原发性肺疾病、胃内容物反流、营养不良、肠内营养占比,均显著高于对照组,而出生胎龄、Apgar评分,则均显著低于对照组,差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析结果显示,合并原发性肺疾病、Apgar评分低、MV治疗时间长、胃内容物反流,均为影响MV新生儿发生VAP的独立危险因素(OR=2.866、3.096、2.735、3.347,95%CI:1.326~5.187、2.053~6.752、1.035~4.068、2.438~7.186,P=0.013、0.006、0.024、<0.001)。结论MV新生儿VAP发生率较高,病原菌主要为革兰阴性菌。合并原发性肺疾病、Apgar评分低、MV治疗时间长、胃内容物反流,均为影响MV新生儿发生VAP的独立危险因素,临床需针对上述危Objective To explore influencing factors of neonatal ventilator-associated pneumonia(VAP)in neonates with the treatment of mechanical ventilation(MV).Methods A total of 68 cases of neonates with treatment of MV who were hospitalized in neonatal intensive care unit(NICU)of Affiliated Hospital of Xuzhou Medical University from June 2018 to May 2021 were selected as research subjects.According to whether neonates developed VAP or not within 48 h after MV treatment,they were included into study group(n=15)and control group(n=53)by retrospective analysis mothod.Gender,gestational age at birth,age,birth weight,mode of delivery,whether it was premature,whether there was primary lung disease,Apgar score,MV duration,reflux of gastric contents,malnutrition,and serum albumin,interleukin(IL)-6,-8 levels were analyzed between two groups by independent-samples t test and chi-square test.Influencing factors of VAP in neonates with MV were analyzed by multivariate unconditional logistic regression analysis method.There were no significant differences in general clinical data as gender composition ratio,age and birth weight of neonates between two groups(P>0.05).This study was approved by Medical Ethics Committee of case collection hospital(Approval No.KY2021010).Results①Incidence of VAP in MV neonates was 22.1%(15/68).Among 16 pathogenic strains,which collected from samples of bronchial secretions of 15 neonates with VAP in study group,14 strains(87.50%)were Gram-negative bacteria,of which Klebsiella pneumoniae and Escherichia coli accounted for a high proportion of 50.00%(8/16)and 18.75%(3/16),respectively.②Duration of MV,proportion of combined with primary lung disease,gastric contents reflux,malnutrition,and enteral nutrition in study group were significantly higher than those of control group,while gestational age at birth and Apgar score were significantly lower than those of control group,and all differences were statistically significant(P<0.05).③Multivariate unconditional logistic regression analysis showed those o

关 键 词：肺炎 呼吸机相关性 通气机 机械 血传病原体 病原菌分布 革兰阴性菌 危险因素 婴儿 新生 

分 类 号：R47[医药卫生—护理学]