【摘要】：【目的】 探討靜脈使用鹽酸氨溴索對(duì)外科重癥監(jiān)護(hù)病房中機(jī)械通氣患者呼吸機(jī)相關(guān)性肺炎發(fā)病的影響，探索預(yù)防呼吸機(jī)相關(guān)性肺炎的新途徑。 【方法】 在福州市某綜合性三級(jí)甲等醫(yī)院外科重癥監(jiān)護(hù)病房，采用隊(duì)列研究設(shè)計(jì)。以靜脈使用鹽酸氨溴索為暴露因素，納2010年1月1日至2011年12月31日機(jī)械通氣滿96小時(shí)的患者為調(diào)查對(duì)象，調(diào)查隨訪患者第一天至第五天的生理指標(biāo)及呼吸機(jī)相關(guān)性肺炎的病原學(xué)資料，，比較氨溴索組間呼吸機(jī)相關(guān)性肺炎的發(fā)病情況，建立Cox比例風(fēng)險(xiǎn)回歸模型校正氨溴索對(duì)呼吸機(jī)相關(guān)性肺炎的影響，通過(guò)單因素重復(fù)測(cè)量設(shè)計(jì)的方差分析評(píng)估鹽酸氨溴索對(duì)患者體溫、動(dòng)脈血pH值和氧合指數(shù)的影響。以上統(tǒng)計(jì)分析采用SPSS19.0軟件和SAS9.0軟件。 【結(jié)果】 1.呼吸機(jī)相關(guān)性肺炎發(fā)病情況 納入研究對(duì)象137例，共觀察944機(jī)械通氣日，發(fā)病96例，發(fā)病密度101.69/1000機(jī)械通氣日。靜脈使用氨溴索組呼吸機(jī)相關(guān)性肺炎的發(fā)病密度83.84/1000機(jī)械通氣日，未使用組的發(fā)病密度120.88/1000機(jī)械通氣日（P＜0.05）。 2.呼吸機(jī)相關(guān)性肺炎患者的病原檢出情況 共培養(yǎng)出85株病原菌。其中鮑曼不動(dòng)桿菌28株，對(duì)各類抗菌藥物耐藥性均達(dá)到80.00%以上。有無(wú)靜脈使用鹽酸氨溴索組間病原菌構(gòu)成差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 3.呼吸機(jī)相關(guān)性肺炎影響因素 呼吸機(jī)相關(guān)性肺炎的危險(xiǎn)因素是未靜脈使用鹽酸氨溴索（HR=1.781,95%CI1.153~2.752），其他的危險(xiǎn)因素還有氣管插管機(jī)械通氣（HR=1.552，95%CI1.012~2.380）和高年齡別（HR=1.435，95%CI1.042~1.975）；保護(hù)因素有使用胃黏膜保護(hù)劑（HR=0.607，95%CI0.383~0.961）。靜脈使用鹽酸氨溴索與人工氣道類型和胃黏膜保護(hù)劑使用無(wú)相加交互作用。 4.鹽酸氨溴索與各生理指標(biāo)關(guān)系 靜脈使用鹽酸氨溴索組間患者體溫、動(dòng)脈血pH值和氧合指數(shù)對(duì)數(shù)值差異均無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。【結(jié)論】 1.靜脈使用鹽酸氨溴索可以降低外科重癥監(jiān)護(hù)病房患者呼吸機(jī)相關(guān)性肺炎的發(fā)病密度，并且延后發(fā)病時(shí)間，但對(duì)呼吸機(jī)相關(guān)性肺炎病死率無(wú)影響。 2.靜脈使用鹽酸氨溴索組間的呼吸機(jī)相關(guān)性肺炎的病原構(gòu)成相似。 3.靜脈使用鹽酸氨溴索對(duì)機(jī)械通氣患者早期的體溫、動(dòng)脈血pH值和氧合指數(shù)對(duì)數(shù)值無(wú)影響。 4.調(diào)查現(xiàn)場(chǎng)的呼吸機(jī)相關(guān)性肺炎發(fā)病率高，鮑曼不動(dòng)桿菌呼吸機(jī)相關(guān)性肺炎構(gòu)成高，并且呈現(xiàn)多藥耐藥性。 5.其他呼吸機(jī)相關(guān)性肺炎的保護(hù)因素還有低年齡別、使用胃黏膜保護(hù)劑和氣管切開(kāi)機(jī)械通氣。
[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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.1

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