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目的分析新生儿呼吸机相关性肺炎(VAP)的临床高危因素及病原学特点。方法机械通气(MV)超过48h的新生儿135例分为VAP组(65例)和非VAP组(70例)。分析临床高危因素与新生儿VAP发生的相关性及病原菌分布情况等。结果 VAP组患儿病死率高于非VAP组(20.00%vs.7.14%)(P<0.05)。单因素分析显示,两组患儿在出生体重<1500g、胎龄<37周、MV持续时间≥3d、气管内吸引≥6次/天、气管插管次数和氧合指数≥200均有统计学差异(P<0.05或P<0.01)。多因素Logistic回归分析显示,MV持续时间≥3d、气管内吸引≥6次/天和氧合指数≥200是VAP发生的危险因素(P<0.01或P<0.05)。痰培养共分离出48株病原菌,以革兰阴性杆菌为主,占77.08%。结论 VAP的高危因素众多;其致病菌主要是革兰阴性杆菌。
Objective To analyze the clinical risk factors and etiological characteristics of neonatal ventilator-associated pneumonia (VAP). Methods 135 neonates with mechanical ventilation (MV) over 48h were divided into VAP group (65 cases) and non-VAP group (70 cases). Analysis of clinical risk factors and the occurrence of neonatal VAP and the distribution of pathogens. Results The mortality of children in VAP group was higher than that in non-VAP group (20.00% vs.7.14%, P <0.05). Univariate analysis showed that there was statistical significance between the two groups in birth weight <1500g, gestational age <37 weeks, MV duration> 3d, intratracheal suction> 6 times / day, tracheal intubation times and oxygenation index> 200 Difference (P <0.05 or P <0.01). Multivariate logistic regression analysis showed that duration of MV ≥3 days, intratracheal aspiration ≥6 beats / day and oxygenation index ≥200 were risk factors of VAP (P <0.01 or P <0.05). A total of 48 strains of pathogens were isolated from sputum culture, mainly Gram-negative bacilli, accounting for 77.08%. Conclusion There are many risk factors of VAP. The pathogens of Gram-negative bacteria are Gram-negative bacilli.