综合医院呼吸机相关性肺炎发生情况及相关因素分析

刘玉岭; 夏宏林; 张会平; 刘杰; 郝维敏

doi:10.16766/j.cnki.issn.1674-4152.002430

综合医院呼吸机相关性肺炎发生情况及相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002430

1.
安徽医科大学附属宿州医院临床中心实验室，安徽宿州 234000
2.
安徽医科大学附属宿州医院医院感染管理科

基金项目:

安徽省重点研究与开发计划项目 202004j07020026

宿州市科技计划项目 SZSKJJZC031

详细信息

通讯作者:
郝维敏，E-mail：13955789317@126.com

中图分类号: R563.1
计量
- 文章访问数: 132
- HTML全文浏览量: 79
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-18
- 网络出版日期: 2022-08-20

Analysis on the incidence and related factors of ventilator-related pneumonia in a general hospital

1.
Department of Clinical Center Laboratory, Suzhou Hospital of Anhui Medical University, Suzhou, Anhui 234000, China

摘要

摘要: 目的探讨重症监护病房(ICU)呼吸机相关性肺炎(VAP)发生情况和相关因素，为综合医院制定切实可行的VAP感染防控策略提供依据。方法 2017—2018年在某综合医院ICU(包括ICU、EICU和NICU)开展VAP目标性监测，对使用呼吸机和发生VAP的患者进行调查，分析VAP发生情况、相关因素和病原菌特点。使用SPSS 20.0统计学软件进行数据分析，应用单因素分析和多因素logistic回归模型分析VAP发生的相关因素。结果 (1) 2017—2018年ICU患者的呼吸机使用率为33.58%，共发生VAP感染58例次，感染率为5.89‰。2018年ICU患者呼吸机使用率较2017年低，差异有统计学意义(P＜0.05)。(2)年龄(P＜0.001)、脑出血(P=0.028)、气管切开(P=0.009)、患者住院天数(P＜0.001)和呼吸机使用天数(P＜0.001)是VAP的危险因素，差异有统计学意义。年龄、气管切开和患者使用呼吸机天数与VAP的发生密切相关(OR＞1，P＜0.05)。(3)VAP相关病原菌培养居于前列的分别为：鲍曼不动杆菌(27株，58.62%)、肺炎克雷伯菌(17株，24.14%)、奇异变形杆菌(4株，6.90%)和铜绿假单胞菌(4株，6.90%)。结论综合医院应加强VAP监测和防控，关注危险因素，降低VAP发生率。
- 呼吸机相关性肺炎 /
- 危险因素 /
- 防控
Abstract: Objective To investigate the incidence and related factors of ventilator associated pneumonia (VAP) in the intensive care unit (ICU) of a general hospital, and guide the prevention and control of VAP. Methods Target monitoring of VAP was carried out in the ICU of a general hospital (including ICU, EICU and NICU) from 2017 to 2018. Patients on ventilator and patients with VAP were investigated. The occurrence of VAP, related factors and pathogen characteristics were analysed. SPSS 20.0 software was used to establish a multivariate logistic regression model and analyse the related factors of VAP. Results (1) The utilisation rate of ventilators in ICU patients was 33.58%, a total of 58 cases of VAP infection occurred, and the infection rate of VAP was 5.89‰. The use rate of ventilators in ICU patients in 2018 was lower than that in 2017, and the difference was statistically significant (P < 0.05). (2) Age (P < 0.001), cerebral haemorrhage (P=0.028), tracheotomy (P=0.009), length of stay in the hospital (P < 0.001) and length of ventilator use (P < 0.001) were risk factors for VAP, whilst age, tracheotomy and length of ventilator use were independent risk factors for VAP (OR>1, P < 0.05). (3) The top VAP-related pathogens were Acinetobacter baumannii (27, 58.62%), Klebsiella pneumoniae (17, 24.14%), Proteus mirabilis (4, 6.90%) and Pseudomonas aeruginosa (4, 6.90%). Conclusion The monitoring and prevention of VAP should be strengthened, and the risk factors should be focused to reduce the incidence of VAP.
- Ventilator associated pneumonia /
- Risk factors /
- Prevention and control measures

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表 1 2017—2018年ICU患者呼吸机使用情况和VAP发生情况

Table 1. Occurrence of VAP in ICU patients from 2017 to 2018

调查时间	ICU患者住院时间(d)	呼吸机使用时间(d)	呼吸机使用率(%)	感染例次数	千日感染率(‰)
2017年	14 928	5 283	35.39	34	6.44
2018年	14 404	4 569	31.72	24	5.25
合计	29 332	9 852	33.58	58	5.89
注：呼吸机使用率比较，χ²=44.252，P＜0.001；VAP感染率比较，χ²=0.444，P=0.510。

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表 2 VAP相关因素的单因素分析

Table 2. Univariate analysis of the related factors of VAP

组别	例数	年龄(x±s，岁)	基础疾病[例(%)]					手术[例(%)]
组别	例数	年龄(x±s，岁)	脑梗死	脑出血	肺部感染	高血压	糖尿病	手术[例(%)]
VAP组	58	76.11±2.91	27(46.55)	20(34.48)	48(82.76)	24(41.38)	12(20.69)	14(24.14)
非VAP组	55	65.79±12.17	20(36.36)	9(16.36)	40(72.73)	29(52.73)	12(21.82)	11(20.00)
统计量		6.273^a	1.206^b	4.858^b	1.649^b	1.460^b	0.021^b	0.281^b
P值		＜0.001	0.272	0.028	0.199	0.227	0.893	0.596

组别	例数	侵入性操作[例(%)]				住院时间(x±s，d)	使用呼吸机时间[(M(P₂₅, P₇₅)，d]	APACHE Ⅱ评分(x±s，分)
组别	例数	留置导尿管	中心静脉置管	气管插管	气管切开	住院时间(x±s，d)	使用呼吸机时间[(M(P₂₅, P₇₅)，d]	APACHE Ⅱ评分(x±s，分)
VAP组	58	56(96.55)	38(65.52)	40(68.97)	18(31.03)	53.71±18.18	16.5(12.0，34.0)	20.80±1.98
非VAP组	55	49(89.09)	43(78.18)	46(83.64)	6(10.91)	22.42±9.49	6.0(3.0，11.0)	24.44±9.89
统计量		2.389^b	2.231^b	3.341^b	6.835^b	11.380^a	582.000^c	2.746^a
P值		0.122	0.135	0.068	0.009	＜0.001	＜0.001	0.007
注：^a为t值，^b为χ²值, ^c为U值。

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表 3 VAP的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of VAP

变量	B	SE	Wald χ²	P值	OR(95% CI)
年龄	0.040	0.015	8.562	0.003	1.041(1.011~1.072)
脑出血	0.522	0.564	0.857	0.355	1.685(0.558~5.085)
气管切开	1.319	0.672	3.850	0.049	3.740(1.002~13.968)
住院天数	0.003	0.008	0.169	0.681	1.003(0.987~1.020)
使用呼吸机天数	0.061	0.026	5.325	0.021	1.063(1.009~1.119)

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表 4 VAP相关病原菌检出情况及其构成比

Table 4. VAP-related pathogenic bacteria detection and composition ratio

病原菌	检出株数	构成比(%)
鲍曼不动杆菌	27	46.55
肺炎克雷伯菌	17	29.31
奇异变形杆菌	4	6.90
铜绿假单胞杆菌	4	6.90
金黄色葡萄球菌	2	3.45
粘质沙雷菌	2	3.45
大肠埃希菌	1	1.72
真菌	1	1.72
合计	58	100.00

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