摘要
目的 探讨新生儿重症监护病房呼吸机相关肺炎 (VAP)的临床特点和危险因素。方法 对新生儿重症监护病房 5 2例并发VAP的病人与同期应用呼吸机治疗超过 4 8h的 2 0 7例新生儿进行回顾性对照分析。比较两组患者的临床特点 ,采用非条件Logistic回归进行多因素分析并计算OR值及OR的 95 %可信限 (95 %CI)。结果 新生儿VAP的发病率为 2 0 0 8% ,致病菌以革兰阴性菌为主 (占 82 14 % )。多因素非条件Logistic回归分析显示 :再插管 (OR =5 341,95 %CI =2 0 31～ 14 0 4 4 )、机械通气时间 (OR =4 789,95 %CI=2 2 0 4～ 10 4 0 4 )、使用中枢抑制剂 (OR =3 797,95 %CI =1 76 7～ 8 5 16 )、气管内吸引 (OR =3 4 87,95 %CI=1 6 35～ 7 4 37)为新生儿VAP的危险因素。结论 VAP在机械通气的新生儿中发生率高 ,再插管、机械通气时间、使用中枢抑制剂、气管内吸引与其发生有密切关系。
Objective To explore the clinical characteristics and risk factors of ventilator-associated pneumonia (VAP) in neonatal intensive care unit (NICU) patients.Methods A retrospective case-control study was conducted at the NICU on 259 patients who needed ventilator for more than 48 hours. Non-conditional logistic regression analysis was performed to determine independent predictors for ventilator-associated pneumonia. The odds ratios (OR) and their 95% confidence intervals (95%CI) were estimated.Results There were 52 episodes of VAP in 259 patients who were mechanically ventilated more than 48 hours.The incidence of VAP was 20.08%. The main pathogens were G - bacterium (82.14%).By non-conditional logistic regression analysis, reintubation (OR=5.341, 95%CI=2.031～14.044),duration of mechanical ventilation (OR=4.789, 95%CI=2.204～10.404) ,treatment with CNS suppressant(OR=3.797,95%CI=1.767～8.516 ) , endotracheal suctioning (OR=3.487,95%CI=1.635～7.437) independently predicted neonatal VAP.Conclusion VAP occurs at significant rates among mechanically ventilated NICU patients and is associated with processes of care. The risk factors of neonatal VAP were reintubation, duration of ventilation, treatment with CNS suppressant and endotracheal suctioning. Additional studies are necessary to develop interventions to prevent neonatal VAP.
出处
《中华急诊医学杂志》
CAS
CSCD
2004年第4期257-260,共4页
Chinese Journal of Emergency Medicine
