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目的探讨机械通气各项影响因素对继发呼吸机相关性肺炎(VAP)的影响。方法回顾性、连续性纳入接受机械通气患者的临床资料,并进一步筛选其中并发VAP的患者。录入所纳入患者的一般情况、合并情况、既往史、个人史、用药史、各项机械通气的护理细节为潜在影响因素。以所纳入患者是否继发VAP为因变量,上述登记的各项潜在影响因素为自变量,采用单因素和多因素logistic回归分析机械通气患者继发VAP的独立护理影响因素。结果共纳入571例机械通气患者,其中163例患者继发VAP。最终logistic回归分析结果显示:APACHEⅡ评分、既往慢性阻塞性肺疾病、并发胃内容物反流、定时吸痰是机械通气患者继发VAP的独立影响因素;经口腔气管插管、使用鼻-空肠管鼻饲、泵注法鼻饲、定时吸引声门下分泌物、每天更换冷凝液、严格限制探视为继发VAP的独立保护因素。结论影响VAP发生的因素众多,需要全方位、多层次干预,医护人员应提高认识和自身业务能力,积极参与防控,对于本研究已探明的影响因素加以应用,从而切实有效地降低VAP的发生。
Objective To investigate the influence of various factors of mechanical ventilation on secondary ventilator associated pneumonia (VAP). Methods The clinical data of patients undergoing mechanical ventilation were retrospectively and continuously included, and the patients with concurrent VAP were further screened. General information included in the inclusion of patients, the merger, past history, personal history, medication history, the details of the various mechanical ventilation ventilation as a potential impact factors. According to whether the secondary VAP was included as the dependent variable or not, all potential influencing factors of the above registration were independent variables. Univariate and multivariate logistic regression analysis was used to analyze the independent nursing influencing factors of secondary VAP in patients with mechanical ventilation. Results A total of 571 patients with mechanical ventilation were enrolled, 163 of whom were secondary to VAP. The results of logistic regression analysis showed that APACHEⅡscore, chronic obstructive pulmonary disease (COPD), reflux of gastric contents and timed sputum aspiration were the independent influencing factors of secondary VAP in patients with mechanical ventilation. Oral endotracheal intubation, nasal-jejunal tube Nasal feeding, nasal pump method, regularly to attract subglottic discharge, condensate replacement every day, strictly limit the visit as an independent secondary VAP protection factor. Conclusion There are many factors influencing the occurrence of VAP and need comprehensive and multi-level intervention. The medical staff should raise their awareness and self-service ability, actively participate in the prevention and control, and apply the factors that have been proved in this study, so as to effectively reduce the VAP occur.