重症监护室医院获得性肺炎病原菌监测及风险因素预测模型构建研究  

Research on the monitoring of pathogens and the prediction model of risk factors for hospital-acquired pneumonia in intensive care unit

作　　者：张向君[1] 朱敬蕊[1] 王丽[1] 李静 ZHANG Xiangjun;ZHU Jingrui;WANG Li;LI Jing(Department of Infectious Disease Control,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China;不详)

机构地区：[1]蚌埠医学院第一附属医院院感科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院检验科

出　　处：《中华全科医学》2023年第6期1053-1055,1063,共4页Chinese Journal of General Practice

基　　金：安徽省教育厅重点项目(KJ2018A1001);蚌埠医学院校级重点研究项目(BYKY2019198skZD)。

摘　　要：目的研究重症监护室(ICU)医院获得性肺炎(hospital-acquired pneumonia,HAP)相关危险因素,了解HAP的病原菌构成。构建并评价HAP发生的风险因素预测模型,便于风险人群筛查,以防控HAP的发生。方法收集某综合性医院综合ICU 2020年1月—2021年3月住院患者资料,同时对痰标本分离病原菌进行监测。采用logistic回归分析构建HAP风险因素预测模型并评价。结果共纳入研究病例570例,其中HAP 34例。HAP患者痰标本中分离病原菌以革兰氏阴性菌为主。多因素分析显示,营养不良、侵袭性操作、住ICU天数>10 d、肺部慢性疾病是患者发生HAP的独立危险因素(均P<0.05)。建立回归模型:logit(P)=-7.870+2.496×营养不良+2.173×侵袭性操作+1.440×住ICU天数>10 d+1.054×肺部慢性疾病。Hosmer和Lemeshow拟合优度检验:χ^(2)=3.022,P=0.933。ROC曲线下面积为0.895,95%CI为0.847~0.943。结论HAP患者痰标本分离菌以革兰氏阴性菌为主。营养不良、侵袭性操作、住ICU天数>10 d、肺部慢性疾病是ICU患者发生HAP的独立危险因素。利用logistic回归分析构建风险因素预测模型有较好的预测效果。Objective To study the risk factors of hospital-acquired pneumonia(HAP)in intensive care unit(ICU)and the composition of HAP pathogens.To construct and evaluate the risk prediction model of HAP,so as to facilitate the screening of risk population and prevent and control the occurrence of HAP.Methods Data of hospitalized patients in the comprehensive ICU of a general hospital from January 2020 to March 2021 were collected,and pathogenic bacteria were isolated and monitored.Logistic regression analysis was used to construct the risk factor prediction model and evaluate it.Results A total of 570 cases were included in this study,including 34 cases of HAP.The pathogens isolated from sputum specimens of HAP patients were mainly gram-negative bacteria.Multivariate analysis showed that malnutrition,invasive operation,length of stay in ICU>10 days and chronic pulmonary disease were independent risk factors for HAP(P<0.05).Regression model was established:logit(P)=-7.870+2.496×malnutrition+2.173×invasive operation+1.440×length of stay in ICU>10 days+1.054×chronic pulmonary disease.Hosmer and Lemeshow goodness-of-fit test:χ^(2)=3.022,P=0.933.The area under the ROC curve was 0.895,95%CI was 0.847-0.943.Conclusion The bacteria isolated from HAP sputum specimens are mainly gram-negative bacteria.Malnutrition,invasive operation,length of stay in ICU>10 days and chronic pulmonary disease are independent risk factors for HAP in ICU patients.The risk factor prediction model constructed by logistic regression analysis can achieve better prediction effect.

关 键 词：医院获得性肺炎 重症监护室 风险因素预测模型 

分 类 号：R563.1[医药卫生—呼吸系统] R372[医药卫生—内科学]