中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2009年
2期
134-136,139
,共4页
田鸾英%Aaron Hamvas
田鸞英%Aaron Hamvas
전란영%Aaron Hamvas
呼吸机相关性肺炎%婴儿,新生%危险因素%病原学
呼吸機相關性肺炎%嬰兒,新生%危險因素%病原學
호흡궤상관성폐염%영인,신생%위험인소%병원학
Ventilator-associated pneumonia%Infant,newborn%Risk factor%Etiology
目的 了解新生儿呼吸机相关性肺炎(VAP)的临床特征和高危因素,为VAP的预防和治疗提供借鉴.方法 对2005年1月至2006年12月入住华盛顿大学医学院圣路易斯儿童医院NICU的所有新生儿临床资料进行回顾性分析.结果 682例接受了机械通气的患儿中,527例机械通气时间≥148 h,其中发生VAP 79例,按体质量分层的每1 000个呼吸机通气日VAP发生率分别是≤1 000 g组6.3,1 001～1 500 g组5.8,1 501～2 500 g组5.6,＞2 500 g组3.6.病原菌以革兰阴性杆菌为主,占86.09%,其中最常见的是铜绿假单胞菌、肠杆菌、肺炎克雷白菌、嗜麦芽窄食单胞菌和黏质沙雷菌.革兰阳性球菌主要为肠球菌和金黄色葡萄球菌.Logistic回归分析发现,低胎龄和机械通气时间是新生儿VAP的独立预测因素,OR及95%CI分别是0.886(0.839～0.943)和1.037(1.027～1.046).结论 VAP在低胎龄儿中发生率较高,可能是导致其住院时间延长的原因之一;尽可能缩短机械通气时间可能会降低VAP的发生率.
目的 瞭解新生兒呼吸機相關性肺炎(VAP)的臨床特徵和高危因素,為VAP的預防和治療提供藉鑒.方法 對2005年1月至2006年12月入住華盛頓大學醫學院聖路易斯兒童醫院NICU的所有新生兒臨床資料進行迴顧性分析.結果 682例接受瞭機械通氣的患兒中,527例機械通氣時間≥148 h,其中髮生VAP 79例,按體質量分層的每1 000箇呼吸機通氣日VAP髮生率分彆是≤1 000 g組6.3,1 001～1 500 g組5.8,1 501～2 500 g組5.6,＞2 500 g組3.6.病原菌以革蘭陰性桿菌為主,佔86.09%,其中最常見的是銅綠假單胞菌、腸桿菌、肺炎剋雷白菌、嗜麥芽窄食單胞菌和黏質沙雷菌.革蘭暘性毬菌主要為腸毬菌和金黃色葡萄毬菌.Logistic迴歸分析髮現,低胎齡和機械通氣時間是新生兒VAP的獨立預測因素,OR及95%CI分彆是0.886(0.839～0.943)和1.037(1.027～1.046).結論 VAP在低胎齡兒中髮生率較高,可能是導緻其住院時間延長的原因之一;儘可能縮短機械通氣時間可能會降低VAP的髮生率.
목적 료해신생인호흡궤상관성폐염(VAP)적림상특정화고위인소,위VAP적예방화치료제공차감.방법 대2005년1월지2006년12월입주화성돈대학의학원골로역사인동의원NICU적소유신생인림상자료진행회고성분석.결과 682례접수료궤계통기적환인중,527례궤계통기시간≥148 h,기중발생VAP 79례,안체질량분층적매1 000개호흡궤통기일VAP발생솔분별시≤1 000 g조6.3,1 001～1 500 g조5.8,1 501～2 500 g조5.6,＞2 500 g조3.6.병원균이혁란음성간균위주,점86.09%,기중최상견적시동록가단포균、장간균、폐염극뢰백균、기맥아착식단포균화점질사뢰균.혁란양성구균주요위장구균화금황색포도구균.Logistic회귀분석발현,저태령화궤계통기시간시신생인VAP적독립예측인소,OR급95%CI분별시0.886(0.839～0.943)화1.037(1.027～1.046).결론 VAP재저태령인중발생솔교고,가능시도치기주원시간연장적원인지일;진가능축단궤계통기시간가능회강저VAP적발생솔.
Objective To determine the prevalence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in neonates. Methods Data were collected retrospectively among neonates admitted to NICU in St. Louis Children's Hospital in Washington University School of Medicine between January 1,2005 and December 31,2006. Results A total of 682 patients were mechanically ventilated and 79 episodes of VAP occurred in 527 patients who were mechanically ventilated for more than or equal to 48 h. VAP prevalence were 6. 3,5. 8,5.6, and 3.6 per 1 000 ventilator days for patients with birth weight ≤1 000 g, 1 001～1 500 g, 1 501～2 500 g, and＞2 500 g, respectively. By multivariate logistic regression analysis, smaller gestational age and longer duration of mechanical ventilation were found to be predictive of VAP (odds ratio:0. 886 and 1. 037;95% confidence interval:0. 839～0. 943 and 1.027～1.046). Patients with VAP had prolonged length of stay in NICU [ (103.6 4±69. 1) d vs (42. 8 ±46. 5) d]. Gram-negative bacilli were the most commonly isolated organisms (86. 09%). Conclusion VAP occurred at higher rates in neonates with smaller gestational age and might be associated with increased length of stay. Developing a standardized assessment of readiness to wean mechanical ventilatory support would be useful in this patient population.
