PICU重症肺炎合并呼吸衰竭患儿发生VAP的危险因素及干预对策  

Risk Factors and Interventions for Ventilator-Associated Pneumonia in Children with Severe Pneumonia and Respiratory Failure in the PICU

作　　者：陈雪华 娄爱丽 CHEN Xuehua;LOU Aii(Pediatric Intensive Care Unit,Zhoukou Central Hospital,Zhoukou Henan 466000,China;Department of Cardiovascular Surgery,Zhoukou Central Hospital,Zhoukou Henan 466000,China)

机构地区：[1]周口市中心医院PICU,河南周口466000 [2]周口市中心医院心脏血管外科,河南周口466000

出　　处：《临床研究》2025年第2期185-188,共4页Clinical Research

摘　　要：目的探讨儿科重症监护病房(PICU)重症肺炎(SP)合并呼吸衰竭(RF)患儿发生呼吸机相关性肺炎(VAP)的危险因素及干预对策。方法回顾性分析2021年2月至2023年1月在周口市中心医院PICU接受治疗的SP合并RF患儿共计124例,统计VAP发生情况,将发生VAP的患儿分为VAP组,并进行单因素分析与Logistic多因素回归分析相关危险因素。结果在PICU接受治疗的124例SP合并RF患儿中,有28例发生VAP,发生率为22.58%(28/124);VAP组年龄≤3岁、出生体质量<2500 g、气管插管次数>3次、使用抗生素、机械通气时间≥5 d、头部位置仰卧、吸痰次数>3次/d患儿占比高于非VAP组,差异具有统计学意义(P<0.05);Logistic多因素回归分析结果显示,年龄≤3岁(OR=1.995,95%CI 1.685~2.307)、出生体质量<2500 g(OR=1.985,95%CI 1.671~2.221)、气管插管次数>3次(OR=2.054,95%CI 1.756~2.327)、使用抗生素(OR=1.863,95%CI 1.689~2.054)、机械通气时间≥5 d(OR=1.964,95%CI 1.704~2.195)、头部位置仰卧(OR=1.883,95%CI 1.716~2.038)是影响PICU中SP合并RF患儿发生VAP的独立危险因素(P<0.05)。结论SP合并RF患儿在PICU中具有较高的VAP发生率,其发生与年龄、出生体质量、气管插管次数、使用抗生素、机械通气时间及头部位置有关,临床应采取有效的干预对策,降低VAP发生风险。Objective To explore the risk factors and intervention strategies for the occurrence of ventilator-associated pneumonia(VAP)in pediatric patients with severe pneumonia(SP)complicated by respiratory failure(RF)in the Pediatric Intensive Care Unit(PICU).Methods A retrospective analysis was performed on 124 patients with SP and RF treated in the PICU of Zhoukou Central Hospital from February 2021 to January 2023.The incidence of VAP was recorded,and patients who developed VAP were categorized into the VAP group.A univariate analysis and logistic multivariate regression analysis were conducted to identify related risk factors.Results Among the 124 patients treated in the PICU for SP complicated by RF,28 developed VAP,resulting in an incidence rate of 22.58%(28/124).In the VAP group,the percentage of patients aged≤3 years,with a birth weight<2500 g,more than 3 intubations,those receiving antibiotics,those with mechanical ventilation duration≥5 days,those with the head position supine,and those with suction frequency>3 times/day were significantly higher than in the non-VAP group(P<0.05).The results of the logistic multivariate regression analysis indicated that age≤3 years(OR=1.995,95%CI 1.685~2.307),birth weight<2500 g(OR=1.985,95%CI 1.671~2.221),more than 3 intubations(OR=2.054,95%CI 1.756~2.327),use of antibiotics(OR=1.863,95%CI 1.689~2.054),mechanical ventilation duration≥5 days(OR=1.964,95%CI 1.704~2.195),and supine head position(OR=1.883,95%CI 1.716~2.038)were independent risk factors for the occurrence of VAP in patients with SP and RF in the PICU(P<0.05).Conclusion Children with SP and RF in the PICU have a high incidence of VAP,which is associated with age,birth weight,number of intubations,use of antibiotics,duration of mechanical ventilation,and head position.Effective intervention strategies should be implemented to reduce the risk of VAP.

关 键 词：儿科重症监护病房 重症肺炎 呼吸衰竭 呼吸机相关性肺炎 危险因素 

分 类 号：R473.72[医药卫生—护理学]