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目的探讨急诊重症监护病房(EICU)呼吸机相关性肺炎(VAP)患者中鲍氏不动杆菌感染的临床预测因素,以期提高预防意识,降低其感染发生率。方法回顾性分析2009年7月-2015年6月243例入住EICU的VAP患者临床资料,数据采用SPSS 18.0软件进行统计分析。结果 243例VAP患者发生鲍氏不动杆菌性呼吸机相关性肺炎(AB-VAP)54例,发生率为22.22%;单因素分析发现,多种因素有预测AB-VAP价值;多因素logistic回归分析发现,机械通气时间≥15d、急性生理及慢性健康评分≥21、糖皮质激素的使用及气管切开具有独立预测价值。结论长时间机械通气、急性生理及慢性健康Ⅱ评分高、使用激素及气管切开为EICU VAP患者发生鲍氏不动杆菌感染的独立预测因素,尽早脱机、加强营养支持治疗、谨慎使用激素、严把气管切开指征等措施有可能降低AB-VAP的发生。
Objective To investigate the clinical predictors of Acinetobacter baumannii infection in emergency intensive care unit (EICU) patients with ventilator associated pneumonia (VAP), in order to improve the prevention awareness and reduce the incidence of infection. Methods The clinical data of 243 VAP patients admitted to EICU from July 2009 to June 2015 were retrospectively analyzed. The data were analyzed by SPSS 18.0 software. Results Among the 243 patients with VAP, 54 cases of AB-VAP (22.22%) had AB-VAP. The univariate analysis showed that AB-VAP value was predicted by many factors. Multivariate logistic regression Analysis found that mechanical ventilation ≥ 15d, acute physical and chronic health score ≥ 21, glucocorticoid use and tracheotomy with independent predictive value. Conclusion Long-term mechanical ventilation, acute physiology and chronic health Ⅱ score high, the use of hormones and tracheostomy for EICU VAP patients with Acinetobacter baumannii independent predictors of infection, as soon as possible offline, to strengthen nutritional support and care, cautious use of hormones, Strict tracheotomy indications and other measures may reduce the occurrence of AB-VAP.