新生儿重症监护室患儿并发呼吸机相关肺炎危险因素的Meta分析  

Risk Factors for Ventilator-Associated Pneumonia in Children in Neonatal Intensive Care Unit:a Meta-Analysis

作　　者：杨迪 高梦 朱福英 齐家玮 万玉英 YANG Di;GAO Meng;ZHU Fu-ying;QI Jia-wei;WAN Yu-ying(School of Nursing,Nanchang University,Nanchang 330006,China;School of Public Health,Nanchang University,Nanchang 330006,China;Department of Infection of the Second Affiliated Hospital,Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学护理学院,南昌330006 [2]南昌大学公共卫生学院,南昌330006 [3]南昌大学第二附属医院院感科,南昌330006

出　　处：《南昌大学学报（医学版）》2022年第3期42-47,共6页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫生健康委员会科技计划项目(202130449)。

摘　　要：目的系统评价新生儿重症监护室(NICU)患儿并发呼吸机相关肺炎(VAP)的危险因素。方法选取CNKI、万方、中国生物医学文献数据库(CBM)、维普、Web of Science、The Cochrane Library、EMBASE、PubMed等数据库,检索建库至2021年6月关于新生儿重症监护室患儿发生呼吸机相关肺炎危险因素的文献,采用RevMan 5.3软件进行Meta分析。结果经2名研究者完成文献筛选及质量评价后纳入22篇病例对照研究,病例总计4190例,其中VAP组1429例,非VAP组为2761例。Meta分析结果显示,平均机械通气时间(MD=3.44)、机械通气时间≥3 d(OR=7.85)、机械通气时间≥5 d(OR=5.55)、重复插管(OR=3.57)、插管次数≥2次(OR=10.73)、平均住院时间(MD=9.56)、住院时间>14 d(OR=3.62)、平均出生体重(MD=-0.66)、出生体重<2.5 kg(OR=3.08)、出生体重<1.5 kg(OR=2.22)、平均气管内吸引次数(MD=3.76)、气管内吸引次数>3次·d-1(OR=4.63)、气管内吸引≥8次·d-1(OR=4.41)、平均胎龄(MD=-3.09)、胎龄<37周(OR=1.71)、出生时Apgar评分<7分(OR=6.83)、合并肺部疾病(OR=2.88)、留置胃管(OR=3.47)、使用抑酸剂(OR=4.82)、使用H2受体拮抗药(OR=4.10)是NICU患儿并发VAP的危险因素。结论NICU患儿发生VAP的危险因素较多,在使用机械通气辅助呼吸过程中应加强对患儿的监测,早期识别和预防危险因素,以降低VAP的发生。Objective To systematically evaluate the risk factors for ventilator-associated pneumonia(VAP)in children in neonatal intensive care unit(NICU).Methods We searched CNKI,Wanfang,CBM,VIP,Web of Science,the Cochrane Library,EMBASE,PubMed and other databases from inception to June 2021 for literature on risk factors for VAP in NICU children.RevMan 5.3 software was used for the meta-analysis.Results After 2 investigators completed literature screening and quality evaluation,22 case-control studies(4190 cases)were included,including 1429 in VAP group and 2761 in non-VAP group.Meta-analysis results showed that average duration of mechanical ventilation(MD=3.44),duration of mechanical ventilation≥3 d(OR=7.85),duration of mechanical ventilation≥5 d(OR=5.55),repeated intubation(OR=3.57),number of intubation attempts≥2 times(OR=10.73),average length of hospital stay(MD=9.56),length of stay>14 d(OR=3.62),average birth weight(MD=-0.66),birth weight<2.5 kg(OR=3.08),birth weight<1.5 kg(OR=2.22),average number of intratracheal suctions(MD=3.76),number of intratracheal suctions>3 times·d-1(OR=4.63),number of intratracheal suctions≥8 times·d-1(OR=4.41),average gestational age(MD=-3.09),gestational age<37 weeks(OR=1.71),Apgar score at birth<7(OR=6.83),combined pulmonary disease(OR=2.88),indwelling gastric tube(OR=3.47),use of acid suppressants(OR=4.82),and use of H2 receptor antagonists(OR=4.10)were risk factors for VAP in NICU children.Conclusion There are many risk factors for VAP in NICU children.Medical staffin NICU should strengthen monitoring during mechanical ventilation and identify and prevent the risk factors early to reduce the occurrence of VAP in NICU children.

关 键 词：呼吸机相关肺炎 危险因素 新生儿重症监护室 META分析 

分 类 号：R722.6[医药卫生—儿科]