重症颅脑损伤术后机械通气患者发生呼吸机相关肺炎的影响因素分析  

Analysis of influencing factors of ventilator-associated pneumonia in mechanically ventilated patients after severe craniocerebral injuries

作　　者：刘柯 LIU Ke(Internal Medicine ICU of Kaifeng Central Hospital,Kaifeng 475000 Henan,China)

机构地区：[1]开封市中心医院内科ICU,河南开封475000

出　　处：《中国民康医学》2022年第15期15-18,共4页Medical Journal of Chinese People’s Health

摘　　要：目的:分析重症颅脑损伤术后机械通气患者发生呼吸机相关肺炎(VAP)的影响因素。方法:回顾性分析2019年12月至2021年4月该院收治的138例重症颅脑损伤术后机械通气患者的临床资料,统计重症颅脑损伤术后机械通气患者VAP发生情况,并将患者分为VAP组、非VAP组。对可能引起VAP发生的因素依次进行单因素分析及Logistic回归分析。结果:138例患者中,发生VAP 66例,发生率为47.83%(66/138);单因素分析结果显示,VAP组年龄≥60岁、入院时格拉斯哥昏迷量表(GCS)评分<5分、术后机械通气时间≥14 d、气管切开、有颅外复合伤、手术次数>1次、吸痰次数≥3次/d、气道湿化次数≥3次/d者占比高于非VAP组,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,年龄≥60岁、入院时GCS评分<5分、手术次数>1次、术后机械通气时间≥14 d、气道湿化次数≥3次/d、气管切开均为重症颅脑损伤术后机械通气患者发生VAP的独立危险因素(OR>1,P<0.05)。结论:年龄≥60岁、入院时GCS评分<5分、手术次数>1次、术后机械通气时间≥14 d、气道湿化次数≥3次/d、气管切开均为重症颅脑损伤术后机械通气患者发生VAP的独立危险因素,临床应积极给予干预措施,以降低VAP发生风险。Objective:To explore analysis of influencing factors of ventilator-associated pneumonia(VAP) in mechanically ventilated patients after severe craniocerebral injuries.Methods:The clinical data of 138 mechanically ventilated patients after severe craniocerebral injuries admitted to this hospital from December 2019 to April 2021 were retrospectively analyzed.The incidence of VAP in these patients was statistically analyzed.Then,these patients were divided into VAP group and non-VAP group.Univariate analysis and Logistic regression analysis were performed on the related factors that may cause the occurrence of VAP.Results:Among the 138 patients,VAP occurred in 66 cases with an incidence rate of 47.83%(66/138).The univariate analysis showed that the proportions of the patients with age ≥60 years old,GCS score <5 points on admission,postoperative mechanical ventilation time ≥14 days,tracheotomy,extracranial compound injury,the number of operations >1 time,sputum suction number ≥ 3 times/d and airway humidification number ≥3 times/d were higher than those in the non-VAP group,and the differences were statistically significant(P<0.05).Logistic analysis results showed that age ≥60 years old,GCS score< 5 points on admission,number of operations >1 time,postoperative mechanical ventilation time ≥14 days,airway humidification number ≥3 times/d,and tracheotomy were the independent risk factors for VAP in the mechanically ventilated patients after traumatic craniocerebral injuries(OR>1,P<0.05).Conclusions:Age ≥60 years old,GCS score < 5 points on admission,number of operations >1 time,postoperative mechanical ventilation time ≥14 days,airway humidification number ≥3 times/d,and tracheotomy are the independent risk factors for VAP in the mechanically ventilated patients after traumatic craniocerebral injuries.Therefore,clinical interventions should be actively given to reduce the risk of VAP.

关 键 词：重症颅脑损伤 术后 机械通气 呼吸机相关肺炎 年龄 手术次数 

分 类 号：R473[医药卫生—护理学]