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目的:探讨急诊科重症监护室的呼吸机相关性肺炎发生的危险因素,研究相应的预防措施。方法:将2013年3月-2015年3月期间于我院急诊监护室进行机械通气的患者64例作为本研究对象,依据是否出现呼吸机相关性的肺炎而将所研究对象分为肺炎组30例以及非肺炎组34例,相关的危险因素分析主要采用卡方检验以及多因素的回归分析。结果 :单因素分析时,两组患者的抗生素使用时间、APACHEⅡ评分、机械通气时间、低血压、低白蛋白水平、侵入性的操作比率、激素应用率、胃肠道反流和误吸发生率以及是否出现消化道菌群易位等方面比较,差异显著,具有统计学意义;而多因素回归分析时,APACHEⅡ评分≥15分、通气时间≧7天、低白蛋白水平、侵入性操作、激素应用、胃肠道反流和误吸以及消化道菌群易位为危险因素。结论:APACHEⅡ评分≥15分、通气时间≥7天、低白蛋白、侵入性操作、激素应用、胃肠道反流和误吸以及消化道菌群易位为急诊科重症监护室呼吸机相关性的肺炎发生的危险因素,临床需要依据研究所得危险因素以及患者的具体情况采取不同预防措施。
Objective: To investigate the risk factors of ventilator-associated pneumonia in emergency department intensive care unit and to study the corresponding preventive measures. METHODS: Sixty-four patients with mechanical ventilation in our emergency department during March 2013-March 2015 were selected as the study subjects and divided into pneumonia group 30 according to whether there was ventilator-associated pneumonia Cases and non-pneumonia in 34 cases, the relevant risk factors mainly using the chi-square test and multiple regression analysis. Results: In the univariate analysis, the antibiotic use time, APACHE II score, mechanical ventilation time, hypotension, low albumin level, invasive operation rate, hormone utilization rate, gastrointestinal reflux and the incidence of aspiration As well as whether the occurrence of gastrointestinal flora translocation and other aspects, the difference was significant, statistically significant; and multivariate regression analysis, APACHE Ⅱ score ≥ 15 points, ventilation time ≧ 7 days, low albumin levels, invasive procedures, hormones Application, gastrointestinal reflux and aspiration and gastrointestinal flora translocation as risk factors. CONCLUSIONS: APACHEⅡscore ≥15, ventilation ≥7 days, low albumin, invasive procedures, hormonal application, gastrointestinal reflux and aspiration, and gastrointestinal flora translocations were associated with ventilator-related risk in intensive care unit Of the risk factors for pneumonia, clinical needs based on the study of risk factors and the specific circumstances of patients to take different preventive measures.