RICU呼吸机相关性肺炎的特点及危险因素初步分析

发布时间：2018-01-04 08:46

本文关键词：RICU呼吸机相关性肺炎的特点及危险因素初步分析　出处：《苏州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的回顾性分析呼吸重症监护病房(RICU)呼吸机相关性肺炎(VAP)的特点及危险因素,为RICU的VAP防治提供临床数据。方法以2012年3月至2016年1月在苏州大学附属第一医院RICU住院的103例行有创机械辅助的患者为研究对象,按VAP诊断标准将其分为VAP组和非VAP组,对两组患者的临床特点及危险因素进行回顾性分析,危险因素包括患者年龄(60岁及≤60岁),机械通气时间(4天及≤4天),原发病是否系慢性阻塞性肺病(COPD),误吸、昏迷、是否有急性肾功能衰竭、低蛋白血症,糖尿病、使用制酸剂、使用激素、留置胃管,抗菌素联合应用(大于2种)等12项。结果1、COPD、大面积脑卒中(含颅脑肿瘤术后)、重症肺炎是VAP最常见的三种原发病,其中COPD患者达46.6%。2、103例机械通气患者,VAP发生率30.1%,死亡率22.6%;COPD患者VAP发生率为61.3%,死亡率26.3%。两组患者在年龄,性别比较无统计学意义(P0.05),而机械通气时间及死亡率两组间比较有显著统计学意义(P0.01),VAP组患者的机械通气时间长,病死率高。3、VAP组患者痰液中分离到的列前4位的病原菌分别是铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼不动杆菌、金黄色葡萄球菌,其中革兰氏阴性菌合计占检出病原菌的79.2%(42/53);基础疾病为COPD的VAP患者痰液中分离到的前4位病原菌分别为铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、鲍曼不动杆菌。4、将患者年龄(60岁及≤60岁),机械通气时间(4天及≤4天),原发病是否系COPD,误吸、昏迷、是否有急性肾功能衰竭、低蛋白血症,糖尿病、使用制酸剂、使用激素、留置胃管,抗菌素联合应用大于2种等12项相关因素进行分析,结果显示:机械通气时间、COPD、误吸、急性肾功能衰竭、抗菌素联合应用(大于2种)、低蛋白血症等因素有统计学意义(P0.05),是发病的可能危险因素。5、以发病与否为因变量,将单因素分析中与发生有统计学意义的变量为自变量,采用非条件逐步回归模型筛选危险因素。结果显示机械通气时间、误吸、抗菌素联合应用大于2种这3个因素的回归系数均为正值,校正混杂作用后各因素OR值均大于1,并都有统计学意义,说明这3个因素是VAP发生的危险因素,确定为VAP发生的独立危险因素。结论(1)本回顾性研究显示RICU的VAP发生率为30.1%,死亡率为22.6%;其中COPD患者VAP发生率为61.3%,死亡率为26.3%。(2)VAP组患者痰液中分离到的列前4位病原菌分别是铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼不动杆菌、金黄色葡萄球菌,其中革兰氏阴性菌合计占检出病原菌的79.2%;基础疾病为COPD的VAP患者痰液中分离到的前4位病原菌与整个VAP组患者相似。(3)对12项VAP危险因素的分析显示机械通气时间、COPD、误吸、急性肾功能衰竭、抗菌素联合应用(大于2种)、低蛋白血症等因素有统计学意义;多因素回归分析显示机械通气时间、误吸、抗菌素联合应用(大于2种)是VAP发生的独立危险因素。
[Abstract]:Objective To retrospectively analyze the respiratory intensive care unit (RICU) of ventilator-associated pneumonia (VAP) and the characteristics of risk factors, and provide clinical data for prevention and treatment of VAP RICU. Methods from March 2012 to January 2016 in First Hospital Affiliated to Suzhou University RICU in 103 cases of invasive mechanical aids patients as the research object, according to the diagnostic standard of VAP will be divided into VAP group and non VAP group, the clinical characteristics and risk factors of two patients were retrospectively analyzed. The risk factors include age (60 years and less than 60 years old), the duration of mechanical ventilation (4 days and less than 4 days), the primary disease is chronic obstructive pulmonary disease (COPD), aspiration, coma. Whether there is acute renal failure, hypoproteinemia, diabetes, use of antacids, hormone use, indwelling gastric tube, combined use of antibiotics (more than 2) 12. The results of 1 COPD, a large area of stroke (including brain tumor surgery), severe pneumonia is VAP The three most common primary diseases, including COPD patients of 46.6%.2103 patients with mechanical ventilation, the incidence of VAP was 30.1%, the mortality rate was 22.6% VAP; the incidence rate of COPD was 61.3%, the mortality of 26.3%. patients in the two groups in age, gender was not statistically significant (P0.05), and mechanical ventilation time and mortality between the two groups are significant statistical significance (P0.01), duration of mechanical ventilation patients in the VAP group, the fatality rate is high.3, isolated from VAP patients in sputum column before pathogen 4 were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus, gram negative bacteria accounted for detection of 79.2% pathogenic bacteria (42/53); the basic disease isolated from sputum in patients with COPD VAP of the top 4 pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Bacillus.4 Bauman does not move, the age (60 years and less than or equal to At the age of 60), the mechanical ventilation time (4 days and less than 4 days), the primary disease is COPD, aspiration, coma, or acute renal failure, hypoproteinemia, diabetes, use of antacids, hormone use, indwelling gastric tube, combined with more than 2 kinds of antibiotics and other 12 related factors analysis results show that: the time of mechanical ventilation, COPD, aspiration, acute renal failure, combined use of antibiotics (more than 2), there was statistical significance of hypoproteinemia and other factors (P0.05),.5 may be the risk factors, the incidence and not as the dependent variable, single factor analysis and occurrence the statistical significant variables as independent variables, using non conditional stepwise regression model to screen risk factors. The results showed that the duration of mechanical ventilation, aspiration, 2 kinds of regression coefficients of these 3 factors were greater than positive for the combined application of antibiotics for the correction of confounding factors of OR value after use was greater than 1, and there were statistically significant Meaning, the 3 factors are the risk factors of VAP, identified as VAP independent risk factors. Conclusion (1) the retrospective study showed that the RICU incidence rate of VAP was 30.1%, the mortality rate was 22.6%; the VAP incidence rate of COPD was 61.3%, the mortality rate was 26.3%. (2) isolated from VAP patients sputum in the top 4 pathogenic bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus, gram negative bacteria accounted for 79.2% of pathogenic bacteria; basic disease of COPD VAP isolated from sputum in patients with the top 4 pathogens and the whole VAP groups of patients were similar. (3) analysis of 12 risk factors of VAP showed that the duration of mechanical ventilation, COPD, aspiration, acute renal failure, combined use of antibiotics (more than 2), there was statistical significance of hypoproteinemia and other factors; multivariate regression analysis showed that mechanical ventilation time error Suction, combined application of antibiotics (more than 2) is the independent risk factors of VAP.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.1

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