本文關(guān)鍵詞：RICU呼吸機(jī)相關(guān)性肺炎的特點(diǎn)及危險(xiǎn)因素初步分析　出處：《蘇州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的回顧性分析呼吸重癥監(jiān)護(hù)病房(RICU)呼吸機(jī)相關(guān)性肺炎(VAP)的特點(diǎn)及危險(xiǎn)因素,為RICU的VAP防治提供臨床數(shù)據(jù)。方法以2012年3月至2016年1月在蘇州大學(xué)附屬第一醫(yī)院RICU住院的103例行有創(chuàng)機(jī)械輔助的患者為研究對(duì)象,按VAP診斷標(biāo)準(zhǔn)將其分為VAP組和非VAP組,對(duì)兩組患者的臨床特點(diǎn)及危險(xiǎn)因素進(jìn)行回顧性分析,危險(xiǎn)因素包括患者年齡(60歲及≤60歲),機(jī)械通氣時(shí)間(4天及≤4天),原發(fā)病是否系慢性阻塞性肺病(COPD),誤吸、昏迷、是否有急性腎功能衰竭、低蛋白血癥,糖尿病、使用制酸劑、使用激素、留置胃管,抗菌素聯(lián)合應(yīng)用(大于2種)等12項(xiàng)。結(jié)果1、COPD、大面積腦卒中(含顱腦腫瘤術(shù)后)、重癥肺炎是VAP最常見的三種原發(fā)病,其中COPD患者達(dá)46.6%。2、103例機(jī)械通氣患者,VAP發(fā)生率30.1%,死亡率22.6%;COPD患者VAP發(fā)生率為61.3%,死亡率26.3%。兩組患者在年齡,性別比較無統(tǒng)計(jì)學(xué)意義(P0.05),而機(jī)械通氣時(shí)間及死亡率兩組間比較有顯著統(tǒng)計(jì)學(xué)意義(P0.01),VAP組患者的機(jī)械通氣時(shí)間長,病死率高。3、VAP組患者痰液中分離到的列前4位的病原菌分別是銅綠假單胞菌、肺炎克雷伯桿菌、鮑曼不動(dòng)桿菌、金黃色葡萄球菌,其中革蘭氏陰性菌合計(jì)占檢出病原菌的79.2%(42/53);基礎(chǔ)疾病為COPD的VAP患者痰液中分離到的前4位病原菌分別為銅綠假單胞菌、肺炎克雷伯桿菌、金黃色葡萄球菌、鮑曼不動(dòng)桿菌。4、將患者年齡(60歲及≤60歲),機(jī)械通氣時(shí)間(4天及≤4天),原發(fā)病是否系COPD,誤吸、昏迷、是否有急性腎功能衰竭、低蛋白血癥,糖尿病、使用制酸劑、使用激素、留置胃管,抗菌素聯(lián)合應(yīng)用大于2種等12項(xiàng)相關(guān)因素進(jìn)行分析,結(jié)果顯示:機(jī)械通氣時(shí)間、COPD、誤吸、急性腎功能衰竭、抗菌素聯(lián)合應(yīng)用(大于2種)、低蛋白血癥等因素有統(tǒng)計(jì)學(xué)意義(P0.05),是發(fā)病的可能危險(xiǎn)因素。5、以發(fā)病與否為因變量,將單因素分析中與發(fā)生有統(tǒng)計(jì)學(xué)意義的變量為自變量,采用非條件逐步回歸模型篩選危險(xiǎn)因素。結(jié)果顯示機(jī)械通氣時(shí)間、誤吸、抗菌素聯(lián)合應(yīng)用大于2種這3個(gè)因素的回歸系數(shù)均為正值,校正混雜作用后各因素OR值均大于1,并都有統(tǒng)計(jì)學(xué)意義,說明這3個(gè)因素是VAP發(fā)生的危險(xiǎn)因素,確定為VAP發(fā)生的獨(dú)立危險(xiǎn)因素。結(jié)論(1)本回顧性研究顯示RICU的VAP發(fā)生率為30.1%,死亡率為22.6%;其中COPD患者VAP發(fā)生率為61.3%,死亡率為26.3%。(2)VAP組患者痰液中分離到的列前4位病原菌分別是銅綠假單胞菌、肺炎克雷伯桿菌、鮑曼不動(dòng)桿菌、金黃色葡萄球菌,其中革蘭氏陰性菌合計(jì)占檢出病原菌的79.2%;基礎(chǔ)疾病為COPD的VAP患者痰液中分離到的前4位病原菌與整個(gè)VAP組患者相似。(3)對(duì)12項(xiàng)VAP危險(xiǎn)因素的分析顯示機(jī)械通氣時(shí)間、COPD、誤吸、急性腎功能衰竭、抗菌素聯(lián)合應(yīng)用(大于2種)、低蛋白血癥等因素有統(tǒng)計(jì)學(xué)意義;多因素回歸分析顯示機(jī)械通氣時(shí)間、誤吸、抗菌素聯(lián)合應(yīng)用(大于2種)是VAP發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective To retrospectively analyze the respiratory intensive care unit (RICU) of ventilator-associated pneumonia (VAP) and the characteristics of risk factors, and provide clinical data for prevention and treatment of VAP RICU. Methods from March 2012 to January 2016 in First Hospital Affiliated to Suzhou University RICU in 103 cases of invasive mechanical aids patients as the research object, according to the diagnostic standard of VAP will be divided into VAP group and non VAP group, the clinical characteristics and risk factors of two patients were retrospectively analyzed. The risk factors include age (60 years and less than 60 years old), the duration of mechanical ventilation (4 days and less than 4 days), the primary disease is chronic obstructive pulmonary disease (COPD), aspiration, coma. Whether there is acute renal failure, hypoproteinemia, diabetes, use of antacids, hormone use, indwelling gastric tube, combined use of antibiotics (more than 2) 12. The results of 1 COPD, a large area of stroke (including brain tumor surgery), severe pneumonia is VAP The three most common primary diseases, including COPD patients of 46.6%.2103 patients with mechanical ventilation, the incidence of VAP was 30.1%, the mortality rate was 22.6% VAP; the incidence rate of COPD was 61.3%, the mortality of 26.3%. patients in the two groups in age, gender was not statistically significant (P0.05), and mechanical ventilation time and mortality between the two groups are significant statistical significance (P0.01), duration of mechanical ventilation patients in the VAP group, the fatality rate is high.3, isolated from VAP patients in sputum column before pathogen 4 were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus, gram negative bacteria accounted for detection of 79.2% pathogenic bacteria (42/53); the basic disease isolated from sputum in patients with COPD VAP of the top 4 pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Bacillus.4 Bauman does not move, the age (60 years and less than or equal to At the age of 60), the mechanical ventilation time (4 days and less than 4 days), the primary disease is COPD, aspiration, coma, or acute renal failure, hypoproteinemia, diabetes, use of antacids, hormone use, indwelling gastric tube, combined with more than 2 kinds of antibiotics and other 12 related factors analysis results show that: the time of mechanical ventilation, COPD, aspiration, acute renal failure, combined use of antibiotics (more than 2), there was statistical significance of hypoproteinemia and other factors (P0.05),.5 may be the risk factors, the incidence and not as the dependent variable, single factor analysis and occurrence the statistical significant variables as independent variables, using non conditional stepwise regression model to screen risk factors. The results showed that the duration of mechanical ventilation, aspiration, 2 kinds of regression coefficients of these 3 factors were greater than positive for the combined application of antibiotics for the correction of confounding factors of OR value after use was greater than 1, and there were statistically significant Meaning, the 3 factors are the risk factors of VAP, identified as VAP independent risk factors. Conclusion (1) the retrospective study showed that the RICU incidence rate of VAP was 30.1%, the mortality rate was 22.6%; the VAP incidence rate of COPD was 61.3%, the mortality rate was 26.3%. (2) isolated from VAP patients sputum in the top 4 pathogenic bacteria were Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter Bauman, Staphylococcus aureus, gram negative bacteria accounted for 79.2% of pathogenic bacteria; basic disease of COPD VAP isolated from sputum in patients with the top 4 pathogens and the whole VAP groups of patients were similar. (3) analysis of 12 risk factors of VAP showed that the duration of mechanical ventilation, COPD, aspiration, acute renal failure, combined use of antibiotics (more than 2), there was statistical significance of hypoproteinemia and other factors; multivariate regression analysis showed that mechanical ventilation time error Suction, combined application of antibiotics (more than 2) is the independent risk factors of VAP.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R563.1

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