重症监护病房老年患者呼吸机相关肺炎危险因素及病原学特点分析
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摘要
目的明确重症监护病房老年患者呼吸机相关肺炎(VAP)的危险因素和病原学特点,为实施针对性的干预提供参考。方法选取气管切开或气管插管而在该院重症监护病房行呼吸机机械通气治疗的老年患者198例为研究对象,使用回顾性分析的方法对患者的临床资料进行调查,分析老年患者VAP的危险因素和病原学特点。结果调查的198例在重症监护病房行机械通气的老年患者中,有64例诊断罹患VAP,VAP的感染率为32. 32%;多因素Logistic回归分析结果表明:年龄> 70岁、APACHE-Ⅱ得分> 15分、反流误吸、机械通气时间> 5 d、口腔卫生差、抗菌药使用时间> 7 d以及留置胃管等是重症监护病房老年患者发生VAP的危险因素(OR> 1,P <0. 05);从64名罹患VAP患者的痰培养液中,共分离培养出82株病原菌,革兰阴性菌,占68. 29%。结论重症监护病房老年患者VAP的发生率较高,其危险因素较多,革兰阴性菌的比例较高,值得关注。
Objective To clarify risk factors and pathogenic characteristics of ventilator associated pneumonia( VAP) in elderly patients in intensive care unit( ICU),and to provide reference for the implementation of targeted intervention.Methods 198 elderly patients with tracheotomy or endotracheal intubation who were treated with mechanical ventilator ventilation in ICU of our hospital were selected as the study objects. The clinical data of these patients were investigated by retrospective analysis,and the risk factors and pathogenic characteristics of VAP in elderly patients were analyzed.Results Among 198 elderly patients undergoing mechanical ventilation in ICU,64 were diagnosed with VAP,and the infection rate of VAP was 32. 32%. The results of multivariate Logistic regression analysis equation showed that age > 70 years old,APACHE Ⅱ score > 15 points,reflux aspiration,mechanical ventilation time > 5 days,poor oral hygiene,antibiotic use time > 7 days and indwelling gastric tube were risk factors for VAP of elderly patients in ICU( OR > 1,P < 0. 05).82 strains of pathogenic bacteria were isolated and cultured from sputum culture of 64 patients with VAP,and the detection rate of Gram-negative bacterial strains was the highest,accounting for 68. 29%. Conclusion The incidence of VAP in elderly patients in ICU is high with more risk factors. And the proportion of Gram-negative bacteria is high,which is worthy of attention.
Objective To clarify risk factors and pathogenic characteristics of ventilator associated pneumonia( VAP) in elderly patients in intensive care unit( ICU),and to provide reference for the implementation of targeted intervention.Methods 198 elderly patients with tracheotomy or endotracheal intubation who were treated with mechanical ventilator ventilation in ICU of our hospital were selected as the study objects. The clinical data of these patients were investigated by retrospective analysis,and the risk factors and pathogenic characteristics of VAP in elderly patients were analyzed.Results Among 198 elderly patients undergoing mechanical ventilation in ICU,64 were diagnosed with VAP,and the infection rate of VAP was 32. 32%. The results of multivariate Logistic regression analysis equation showed that age > 70 years old,APACHE Ⅱ score > 15 points,reflux aspiration,mechanical ventilation time > 5 days,poor oral hygiene,antibiotic use time > 7 days and indwelling gastric tube were risk factors for VAP of elderly patients in ICU( OR > 1,P < 0. 05).82 strains of pathogenic bacteria were isolated and cultured from sputum culture of 64 patients with VAP,and the detection rate of Gram-negative bacterial strains was the highest,accounting for 68. 29%. Conclusion The incidence of VAP in elderly patients in ICU is high with more risk factors. And the proportion of Gram-negative bacteria is high,which is worthy of attention.
引文
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[5]Al-Sayaghi KM.Prevention of ventilator-associated pneumonia a knowledge survey among intensive care nurses in Yemen[J].Saudi Med J,2014,35(3):269-276.
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[7]程莉莉,张秀月,杨洪艳.某医院综合重症监护病房呼吸机相关肺炎的发病率及危险因素[J].中国感染控制杂志,2017,16(1):70-72.
[8]谢朝云,熊芸,覃家露,等.老年呼吸机相关肺炎患者死亡的危险因素[J].中国感染控制杂志,2018,17(5):413-416.
[9]Lewis SC,Li L,Murphy MV,et al.Risk factors for ventilator associated events:a case control multivariable analysis[J].Crit Care Med,2014,42(8):1839-1848.
[10]Bouza E,Giannella M,Bunsow E,et al.Ventilator associated pneumonia due to meticillin-resistant Staphylococcus aureus:riskfactors and outcome in a large general hospital[J].J Hosp Infect,2012,80(2):150-155.
[2]王伟勇,赵敏,孙智勇,等.ICU呼吸机相关性肺炎危险因素及病原学分析[J].人民军医,2018,61(6):515-518.
[3]钟婉红,陈兰,王秀娟,等.ICU住院老年患者呼吸机相关性肺炎的危险因素研究[J].中国消毒学杂志,2018,35(4):273-275.
[4]徐玉菲,范晓云,姜雪勤,等.呼吸机相关性肺炎病原菌分布及其危险因素分析[J].中华疾病控制杂志,2018,22(9):912-915.
[5]Al-Sayaghi KM.Prevention of ventilator-associated pneumonia a knowledge survey among intensive care nurses in Yemen[J].Saudi Med J,2014,35(3):269-276.
[6]Rello J,Ollendorf DA,Oster G,et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database[J].Chest,2002,122(6):2115-2121.
[7]程莉莉,张秀月,杨洪艳.某医院综合重症监护病房呼吸机相关肺炎的发病率及危险因素[J].中国感染控制杂志,2017,16(1):70-72.
[8]谢朝云,熊芸,覃家露,等.老年呼吸机相关肺炎患者死亡的危险因素[J].中国感染控制杂志,2018,17(5):413-416.
[9]Lewis SC,Li L,Murphy MV,et al.Risk factors for ventilator associated events:a case control multivariable analysis[J].Crit Care Med,2014,42(8):1839-1848.
[10]Bouza E,Giannella M,Bunsow E,et al.Ventilator associated pneumonia due to meticillin-resistant Staphylococcus aureus:riskfactors and outcome in a large general hospital[J].J Hosp Infect,2012,80(2):150-155.