盐酸氨溴索与呼吸机相关性肺炎关系的队列研究

发布时间：2018-08-22 11:33

【摘要】：【目的】探讨静脉使用盐酸氨溴索对外科重症监护病房中机械通气患者呼吸机相关性肺炎发病的影响，探索预防呼吸机相关性肺炎的新途径。【方法】在福州市某综合性三级甲等医院外科重症监护病房，采用队列研究设计。以静脉使用盐酸氨溴索为暴露因素，纳2010年1月1日至2011年12月31日机械通气满96小时的患者为调查对象，调查随访患者第一天至第五天的生理指标及呼吸机相关性肺炎的病原学资料，，比较氨溴索组间呼吸机相关性肺炎的发病情况，建立Cox比例风险回归模型校正氨溴索对呼吸机相关性肺炎的影响，通过单因素重复测量设计的方差分析评估盐酸氨溴索对患者体温、动脉血pH值和氧合指数的影响。以上统计分析采用SPSS19.0软件和SAS9.0软件。【结果】 1.呼吸机相关性肺炎发病情况纳入研究对象137例，共观察944机械通气日，发病96例，发病密度101.69/1000机械通气日。静脉使用氨溴索组呼吸机相关性肺炎的发病密度83.84/1000机械通气日，未使用组的发病密度120.88/1000机械通气日（P＜0.05）。 2.呼吸机相关性肺炎患者的病原检出情况共培养出85株病原菌。其中鲍曼不动杆菌28株，对各类抗菌药物耐药性均达到80.00%以上。有无静脉使用盐酸氨溴索组间病原菌构成差异无统计学意义（P＞0.05）。 3.呼吸机相关性肺炎影响因素呼吸机相关性肺炎的危险因素是未静脉使用盐酸氨溴索（HR=1.781,95%CI1.153~2.752），其他的危险因素还有气管插管机械通气（HR=1.552，95%CI1.012~2.380）和高年龄别（HR=1.435，95%CI1.042~1.975）；保护因素有使用胃黏膜保护剂（HR=0.607，95%CI0.383~0.961）。静脉使用盐酸氨溴索与人工气道类型和胃黏膜保护剂使用无相加交互作用。 4.盐酸氨溴索与各生理指标关系静脉使用盐酸氨溴索组间患者体温、动脉血pH值和氧合指数对数值差异均无统计学意义（P＞0.05）。【结论】 1.静脉使用盐酸氨溴索可以降低外科重症监护病房患者呼吸机相关性肺炎的发病密度，并且延后发病时间，但对呼吸机相关性肺炎病死率无影响。 2.静脉使用盐酸氨溴索组间的呼吸机相关性肺炎的病原构成相似。 3.静脉使用盐酸氨溴索对机械通气患者早期的体温、动脉血pH值和氧合指数对数值无影响。 4.调查现场的呼吸机相关性肺炎发病率高，鲍曼不动杆菌呼吸机相关性肺炎构成高，并且呈现多药耐药性。 5.其他呼吸机相关性肺炎的保护因素还有低年龄别、使用胃黏膜保护剂和气管切开机械通气。
[Abstract]:[objective] to investigate the effect of intravenous use of ambroxol hydrochloride on the incidence of ventilator-associated pneumonia in patients with mechanical ventilation in surgical intensive care unit (ICU). To explore a new way to prevent ventilator-associated pneumonia. [methods] A cohort study was carried out in a surgical intensive care unit of a general Grade 3A hospital in Fuzhou. Patients who received 96 hours of mechanical ventilation from January 1, 2010 to December 31, 2011, were selected as exposure factors for intravenous use of ambroxol hydrochloride. To investigate the physiological indexes and etiological data of ventilator-associated pneumonia (VAP) from the first to the fifth day of follow-up, to compare the incidence of ventilator-associated pneumonia in ambroxol group. Cox proportional risk regression model was established to correct the effect of ambroxol on ventilator-associated pneumonia. The effects of ambroxol hydrochloride on body temperature, arterial pH and oxygenation index were evaluated by single factor repeated analysis of variance (ANOVA). SPSS19.0 software and SAS9.0 software were used in the statistical analysis. [results] 1. The incidence of ventilator-associated pneumonia (VAP) was studied in 137 subjects. A total of 944 mechanical ventilation days were observed, 96 cases were observed, and the incidence density was 101.69% / 1000 days. The incidence density of ventilator-associated pneumonia was 83.84 / 1000 days in intravenous group and 120.88 / 1000 days in untreated group (P < 0.05). A total of 85 strains of pathogenic bacteria were cultured in patients with ventilator-associated pneumonia. Among them, 28 strains of Acinetobacter baumannii were resistant to all kinds of antimicrobial agents. There was no significant difference in the composition of pathogens between groups with or without intravenous use of ambroxol hydrochloride (P > 0.05). The risk factors of ventilator-associated pneumonia were non-intravenous use of ambroxol hydrochloride (HRL 1.781CI = 1.153CI2.752), other risk factors were tracheal intubation mechanical ventilation (HR1.552c95CI1.012122.380) and older age (HR1.43595CI1.042C1.0421.975). The protective factors were the use of gastric mucosal protectant (HRT 0.607, 95 CI 0.383, 0.961). Intravenous use of ambroxol hydrochloride and artificial airway type and gastric mucosal protection agent using no additive interaction. 4. Relationship between Ambroxol Hydrochloride and physiological Indexes there was no significant difference in body temperature, arterial pH value and oxygenation index between the two groups (P > 0.05). [conclusion] 1. Intravenous use of ambroxol hydrochloride could reduce the incidence density of ventilator-associated pneumonia in surgical intensive care unit patients, and delay the onset time, but had no effect on the mortality of ventilator-associated pneumonia. 2. The pathogen composition of ventilator-associated pneumonia was similar between groups treated with ambroxol hydrochloride. Intravenous use of ambroxol hydrochloride had no effect on early body temperature, arterial pH and oxygenation index of patients undergoing mechanical ventilation. 4. The incidence of ventilator-associated pneumonia in the field was high, and that of Acinetobacter baumannii was high. Other protective factors for ventilator-associated pneumonia are low age, gastric mucosal protectant and tracheotomy mechanical ventilation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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