ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施

发布时间：2018-06-08 21:04

  本文选题：机械通气 + 重症监护病房　； 参考：《中华医院感染学杂志》2016年01期

【摘要】：目的探讨ICU机械通气患者发生呼吸机相关性肺炎(VAP)的危险因素及干预措施,为降低VAP发生率提供依据。方法回顾性分析2013年3月-2014年4月医院收治的360例ICU机械通气患者临床资料,分析其病原菌分布及相关危险因素;采用SPSS19.0软件对数据进行统计分析,计数资料比较用χ2或校正χ2检验及Fisher′s精确概率法;对VAP影响因素分析采用单因素与多因素logistic回归分析。结果 360例ICU机械通气患者发生VAP 118例,发生率为32.78%;共检出病原菌142株,其中革兰阴性菌91株占64.08%,以鲍氏不动杆菌、铜绿假单胞菌为主,革兰阳性菌47株占33.10%,以金黄色葡萄球菌为主,真菌5株占3.52%,以白色假丝酵母菌为主;单因素及多因素logistic回归分析发现,年龄60岁、机械通气时间5d、血清白蛋白含量30g/L、APACHEⅡ评分18分、有意识障碍、应用制酸剂、侵入性操作、留置胃管等因素是发生VAP的独立危险因素(P0.05)。结论 ICU机械通气患者发生呼吸机相关性肺炎危险因素较多,应采取针对性措施,严密监控,加强护理措施,以降低VAP发生率。
[Abstract]:Objective to explore the risk factors and intervention measures of ventilator associated pneumonia (VAP) in patients with mechanical ventilation in ICU, and to provide evidence for reducing the incidence of VAP. Methods the clinical data of 360 patients with mechanical ventilation in ICU from March 2013 to April 2014 were retrospectively analyzed, the distribution of pathogenic bacteria and related risk factors were analyzed, and the data were statistically analyzed by SPSS 19.0 software. The count data were compared by 蠂 ~ 2 test or correction 蠂 ~ 2 test and Fisher's exact probability method, and univariate and multi-factor logistic regression analysis were used to analyze the influencing factors of logistic. Results there were 118 cases of VAP in 360 patients with mechanical ventilation in ICU, the incidence rate was 32.788.142 strains of pathogenic bacteria were detected, of which 91 strains were Gram-negative bacteria, mainly Acinetobacter baumannii and Pseudomonas aeruginosa. There were 47 Gram-positive bacteria (33.10%), mainly Staphylococcus aureus, 5 fungi (3.52%) and Candida albicans. Univariate and multivariate logistic regression analysis showed that the age was 60 years old. Mechanical ventilation time (5 days), serum albumin content (30 g / L) Apache 鈪，

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