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目的探讨慢性阻塞性肺疾病急性加重(AECOPD)患者行机械通气中发生呼吸机相关性肺炎(VAP)的相关危险因素,为临床预防AECOPD患者发生VAP提供参考依据。方法选取AECOPD急救中采用机械通气治疗患者142例为研究对象,统计AECOPD机械通气急救中VAP的发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析。结果 142例患者发生VAP 96例,VAP发生率67.6%,共分离出病原菌138株,其中革兰阴性菌96株占69.6%,革兰阳性菌38株占27.5%,真菌4株占2.9%;机械通气持续时间≥3d、合并糖尿病、有吸烟史、气管插管、留置胃管为AECOPD患者发生VAP的独立危险因素。结论 AECOPD患者机械通气治疗后VAP发生率较高,一旦发生VAP,病死率明显增高,住院时间增长,急救中需严格掌握有创呼吸机应用指征,尽量缩短机械通气时间,对合并糖尿病、吸烟史、留置胃管患者积极预防性应用抗菌药物预防VAP的发生。
Objective To investigate the risk factors associated with ventilator-associated pneumonia (VAP) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) during mechanical ventilation and provide a reference for clinical prevention of VAP in patients with AECOPD. Methods AECOPD emergency treatment of 142 patients treated with mechanical ventilation for the study, statistics AECOPD mechanical ventilation in the incidence of VAP, the incidence of VAP related factors by single factor and multivariate logistic regression analysis. Results 96 cases of VAP occurred in 142 cases and 67.6% of VAP in the 142 cases. Among them, 138 strains of pathogens were isolated, of which 96 strains were Gram - negative bacteria, 69.5% were Gram - negative bacteria, 27.5% were Gram - positive bacteria and 2.9% were fungi. Mechanical ventilation duration ≥ 3d, with diabetes, a history of smoking, endotracheal intubation, indwelling gastric tube is an independent risk factor for VAP occurred in AECOPD patients. Conclusion The incidence of VAP after mechanical ventilation in AECOPD patients is high. In the event of VAP, the case fatality rate is significantly increased and the length of hospital stay is increased. In emergency cases, the application of invasive ventilator should be strictly controlled, and the duration of mechanical ventilation should be shortened. History, indwelling gastric tube positive preventive application of antimicrobial agents to prevent the occurrence of VAP.