脑卒中患者行机械通气继发呼吸机相关性肺炎的影响性研究

发布时间：2018-01-06 20:26

本文关键词：脑卒中患者行机械通气继发呼吸机相关性肺炎的影响性研究　出处：《临床肺科杂志》2016年08期 　论文类型：期刊论文

【摘要】：目的探讨脑卒中患者机械通气各项影响因素与继发呼吸机相关性肺炎(Ventilator associated Pneumonia,VAP)的影响性。方法回顾性、连续性纳入2014年7月1日-2015年11月1日期间我院重症监护室所收治脑卒中接受机械通气患者的临床资料。纳入患者的一般情况如性别、年龄、体重指数、既往史。登记本次入院期间的插管方式、鼻饲管选择、鼻饲方式、预防应激性溃疡的用药种类、并发症情况、各种分泌物护理情况、气道湿化情况、排痰情况、更换各种呼吸机配件情况、抬高床头角度、院感规避风险、探视情况、是否气管切开等各项细节。以所纳入患者是否继发VAP为因变量,上述登记的各项潜在影响因素为自变量,采用单因素和多因素logistic回归分析研究患者继发VAP的独立影响因素。结果经纳入、排除标准,共纳入96例患脑卒中的手术患者,其中出血性脑卒中17例、缺血性脑卒中79例。累计36例患者于入院一周内继发VAP、60例患者未继发VAP。最终Logistic回归分析结果显示:其中泵注法鼻饲、雾化湿化、定时吸痰、抬高床头为独立保护因素(P0.05);GCS评分、合并神经源性肺水肿、并发胃内容物反流、机械通气时间为独立危险因素(P0.05)。结论影响VAP的发生因素众多,而脑卒中患者的特殊情况又加重了VAP的发病风险,需要全方位、多层次干预。在临床工作中予以充分注重本研究已探明的影响因素,从而切实有效降低VAP的发生。
[Abstract]:Objective to investigate the influencing factors of mechanical ventilation and Ventilator associated Pneumonia in patients with stroke. Methods retrospective study was made on the influence of VAP. From July 1st 2014 to November 1st 2015, we included the clinical data of stroke patients receiving mechanical ventilation in intensive care unit of our hospital, including the general situation of patients such as sex, age. Body mass index (BMI), past history. Record the way of intubation, selection of nasogastric tube, nasal feeding method, drug types, complications, secretion nursing status, airway humidification. Sputum drainage, replacement of various ventilator accessories, raising bedside angle, hospital risk avoidance, visitation, tracheotomy and other details. Included in the patient with secondary VAP as a dependent variable. The independent factors of secondary VAP were studied by univariate and multivariate logistic regression analysis. The results were included and excluded. A total of 96 patients with cerebral apoplexy were included, including 17 patients with hemorrhagic stroke and 79 patients with ischemic stroke. A total of 36 patients had secondary VAP within one week of admission. The results of Logistic regression analysis showed that nasal feeding, atomization humidification, regular sputum aspiration and raising the bed head were the independent protective factors (P 0.05). GCS score, complicated with neurogenic pulmonary edema, complicated with gastric reflux, mechanical ventilation time is an independent risk factor P0.05.Conclusion there are many factors affecting the occurrence of VAP. The special situation of stroke patients has aggravated the risk of VAP, and needs all-directional, multi-level intervention. In the clinical work, we should pay full attention to the factors that have been identified in this study. In order to effectively reduce the occurrence of VAP.
【作者单位】：伊犁哈萨克自治州奎屯医院呼吸内科;
【分类号】：R743.3;R563.1
【正文快照】： 呼吸衰竭是急性脑卒中最常见的并发症,需紧急气管插管或气管切开行机械通气(Mechanicalventilation)给予患者进一步的生命支持。随着医疗技术的进展,脑卒中患者应用机械通气的范围、层次均逐渐深入,发挥重要疗效[1]。但由此导致的呼吸机相关性肺炎(Ventilator associated Pneu

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