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目的:探讨新生儿呼吸机相关性肺炎(VAP)的短期预后,并分析影响预后的危险因素。方法:回顾性分析我院新生儿科重症监护室(NICU)2013年1月至2016年1月应用有创呼吸机辅助呼吸合并VAP的新生儿47例,选择同期住院且基本情况类似的未合并VAP的新生儿51例作为对照组,分析致病菌感染情况和短期预后,应用多元Logistic回归分析28 d与病死率相关的危险因素,应用受试者工作特征性曲线(ROC)评估危险因素的阈值。结果:入选的98例新生儿中,男63例,女35例,平均胎龄(36.7±3.3)周,两组患儿的一般资料比较差异无统计学意义(P>0.05),但呼吸频率、心率、CRP、PCT、简化临床肺部感染评分(CPIS)比较差异有统计学意义(P<0.05)。病原菌主要为革兰阴性杆菌,且多为耐药菌。随访28 d时,两组的住院时间、机械通气时间、病死率比较差异均有统计学意义(P<0.05)。胎龄、机械通气时间、PCT和简化CPIS为合并VAP的新生儿死亡的独立危险因素。胎龄≤33周、机械通气时间≥4 d、PCT≥2.0μg/L和简化CPIS≥6为相关危险因素的ROC阈值。结论:VAP新生儿多合并耐药菌感染,短期预后差,28 d病死率显著增加。胎龄小、机械通气时间长、PCT水平和CPIS评分高为短期死亡的独立危险因素。
Objective: To investigate the short-term prognosis of neonatal ventilator-associated pneumonia (VAP) and to analyze the risk factors influencing prognosis. Methods: Forty-seven neonates with invasive ventilator-assisted breathing (VAP) combined with neonatal intensive care unit (NICU) from January 2013 to January 2016 in our hospital were retrospectively analyzed. Unconjacted VAP 51 newborns were used as control group to analyze the pathogen infection and short-term prognosis. Multivariate Logistic regression analysis was used to analyze the risk factors associated with mortality at 28 days. The thresholds of risk factors were evaluated using receiver operating characteristic curve (ROC) . Results: There were 63 males and 35 females with an average gestational age of (36.7 ± 3.3) weeks in 98 newborns. There was no significant difference in general data between the two groups (P> 0.05). However, the respiratory rate , Heart rate, CRP, PCT, simplified clinical lung infection score (CPIS) difference was statistically significant (P <0.05). Gram-negative bacteria mainly bacilli, and mostly resistant bacteria. At 28 days of follow-up, there were significant differences in hospitalization time, mechanical ventilation time and mortality between the two groups (P <0.05). Gestational age, duration of mechanical ventilation, PCT, and simplified CPIS were independent risk factors for neonatal death associated with VAP. Gestational age ≤33 weeks, mechanical ventilation ≥4 days, PCT≥2.0μg / L and simplified CPIS≥6 were ROC thresholds for related risk factors. Conclusion: Newborns with VAP are more resistant to bacterial infection, the short-term prognosis is poor, and the 28-day mortality rate is significantly increased. Small gestational age, long mechanical ventilation, high PCT and CPIS scores were independent risk factors for short-term mortality.