【摘要】：【目的】 探討靜脈使用鹽酸氨溴索對外科重癥監(jiān)護病房中機械通氣患者呼吸機相關性肺炎發(fā)病的影響，探索預防呼吸機相關性肺炎的新途徑。 【方法】 在福州市某綜合性三級甲等醫(yī)院外科重癥監(jiān)護病房，采用隊列研究設計。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日機械通氣滿96小時的患者為調查對象，調查隨訪患者第一天至第五天的生理指標及呼吸機相關性肺炎的病原學資料，，比較氨溴索組間呼吸機相關性肺炎的發(fā)病情況，建立Cox比例風險回歸模型校正氨溴索對呼吸機相關性肺炎的影響，通過單因素重復測量設計的方差分析評估鹽酸氨溴索對患者體溫、動脈血pH值和氧合指數(shù)的影響。以上統(tǒng)計分析采用SPSS19.0軟件和SAS9.0軟件。 【結果】 1.呼吸機相關性肺炎發(fā)病情況 納入研究對象137例，共觀察944機械通氣日，發(fā)病96例，發(fā)病密度101.69/1000機械通氣日。靜脈使用氨溴索組呼吸機相關性肺炎的發(fā)病密度83.84/1000機械通氣日，未使用組的發(fā)病密度120.88/1000機械通氣日（P＜0.05）。 2.呼吸機相關性肺炎患者的病原檢出情況 共培養(yǎng)出85株病原菌。其中鮑曼不動桿菌28株，對各類抗菌藥物耐藥性均達到80.00%以上。有無靜脈使用鹽酸氨溴索組間病原菌構成差異無統(tǒng)計學意義（P＞0.05）。 3.呼吸機相關性肺炎影響因素 呼吸機相關性肺炎的危險因素是未靜脈使用鹽酸氨溴索（HR=1.781,95%CI1.153~2.752），其他的危險因素還有氣管插管機械通氣（HR=1.552，95%CI1.012~2.380）和高年齡別（HR=1.435，95%CI1.042~1.975）；保護因素有使用胃黏膜保護劑（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劑使用無相加交互作用。 4.鹽酸氨溴索與各生理指標關系 靜脈使用鹽酸氨溴索組間患者體溫、動脈血pH值和氧合指數(shù)對數(shù)值差異均無統(tǒng)計學意義（P＞0.05）�！窘Y論】 1.靜脈使用鹽酸氨溴索可以降低外科重癥監(jiān)護病房患者呼吸機相關性肺炎的發(fā)病密度，并且延后發(fā)病時間，但對呼吸機相關性肺炎病死率無影響。 2.靜脈使用鹽酸氨溴索組間的呼吸機相關性肺炎的病原構成相似。 3.靜脈使用鹽酸氨溴索對機械通氣患者早期的體溫、動脈血pH值和氧合指數(shù)對數(shù)值無影響。 4.調查現(xiàn)場的呼吸機相關性肺炎發(fā)病率高，鮑曼不動桿菌呼吸機相關性肺炎構成高，并且呈現(xiàn)多藥耐藥性。 5.其他呼吸機相關性肺炎的保護因素還有低年齡別、使用胃黏膜保護劑和氣管切開機械通氣。
[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.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.1

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