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目的:分析儿科重症监护病房(PICU)感染呼吸机相关性肺炎(VAP)的发病率及相关危险因素,为临床机械通气过程中VAP的防治提供参考依据。方法:选取2013年1月至2014年12月在PICU住院治疗且行机械通气时间超过48 h的419例患儿进行回顾性分析,根据是否发生VAP将其分为VAP组与非VAP组,对VAP发生的相关危险因素进行χ2检验及logistic回归分析。结果:419例机械通气时间超过48 h的患儿中,63例发生VAP,VAP的发病率为15.04%;单因素分析发现两组在基础疾病、白蛋白水平、机械通气时间、插管次数、PICU住院时间、APACHEⅡ评分、留置胃管及是否使用激素等方面比较差异有统计学意义(P<0.05);Logistic回归分析显示,白蛋白水平(OR=1.356,P<0.05)、机械通气时间(OR=2.135,P<0.01)、插管次数(OR=1.892,P<0.05)、PICU住院时间(OR=1.683,P<0.05)、APACHE评分(OR=2.642,P<0.05)、留置胃管(OR=1.869,P<0.01)为PICU患儿VAP发生的独立危险因素。结论:PICU患儿VAP的发生受多种危险因素的影响,临床上应针对相关危险因素采取预防措施,有效降低VAP的发生。
OBJECTIVE: To analyze the incidence and related risk factors of ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU) and provide a reference for the prevention and treatment of VAP during clinical mechanical ventilation. Methods: From January 2013 to December 2014 in PICU hospitalized and mechanical ventilation for more than 48 h of 419 cases were analyzed retrospectively, according to whether the occurrence of VAP divided into VAP group and non-VAP group, VAP The occurrence of the relevant risk factors for χ2 test and logistic regression analysis. Results: Among 419 children with mechanical ventilation over 48 hours, VAP occurred in 63 patients and the incidence of VAP was 15.04%. Univariate analysis showed that there was no significant difference in basic diseases, albumin levels, mechanical ventilation time, (P <0.05). Logistic regression analysis showed that albumin level (OR = 1.356, P <0.05), duration of mechanical ventilation ( OR = 2.135, P <0.01), the number of intubation (OR = 1.892, P <0.05), length of hospital stay (OR = 1.683, P < (OR = 1.869, P <0.01) were independent risk factors for VAP in children with PICU. Conclusion: The occurrence of VAP in children with PICU is influenced by many risk factors. Precautionary measures should be taken according to the relevant risk factors so as to effectively reduce the incidence of VAP.