护理学报
護理學報
호이학보
JOURNAL OF NURSING
2014年
10期
13-16
,共4页
外科重症监护室%呼吸机相关性肺炎%危险因素%护理
外科重癥鑑護室%呼吸機相關性肺炎%危險因素%護理
외과중증감호실%호흡궤상관성폐염%위험인소%호리
Surgical Intensive Care Unit%ventilator associated pneumonia%risk factor%nursing care
目的：分析外科重症监护室患者呼吸机相关性肺炎（ventilator associated pneumonia，VAP）的危险因素，并制定针对性的护理对策。方法回顾性分析2012年1-12月广州市某三级甲等医院外科重症监护室收治的104例机械通气超过48 h患者的临床资料，并将患者分为VAP和非VAP组，先以单因素分析筛选出有统计学意义的变量，再使用逐步 Logistic 回归分析确定VAP的显著独立危险因素，并实施针对性护理措施。结果单因素分析显示，机械通气时间、入住外科重症监护室时间、基础疾病、中心静脉置管、急诊、插管方式、输血史、镇静评分、雾化吸入、昏迷、激素、血清白蛋白、上机前48 h使用抗生素、抑酸剂等14项因素差异有统计学意义（P<0.05）；但多因素分析只有机械通气时间、昏迷进入回归方程，是外科重症监护室 VAP的危险因素， OR值分别为2.684和7.547。结论通过对外科重症监护室VAP危险因素的研究分析，于制定科学的护理对策，以有效降低VAP的发生率。
目的：分析外科重癥鑑護室患者呼吸機相關性肺炎（ventilator associated pneumonia，VAP）的危險因素，併製定針對性的護理對策。方法迴顧性分析2012年1-12月廣州市某三級甲等醫院外科重癥鑑護室收治的104例機械通氣超過48 h患者的臨床資料，併將患者分為VAP和非VAP組，先以單因素分析篩選齣有統計學意義的變量，再使用逐步 Logistic 迴歸分析確定VAP的顯著獨立危險因素，併實施針對性護理措施。結果單因素分析顯示，機械通氣時間、入住外科重癥鑑護室時間、基礎疾病、中心靜脈置管、急診、插管方式、輸血史、鎮靜評分、霧化吸入、昏迷、激素、血清白蛋白、上機前48 h使用抗生素、抑痠劑等14項因素差異有統計學意義（P<0.05）；但多因素分析隻有機械通氣時間、昏迷進入迴歸方程，是外科重癥鑑護室 VAP的危險因素， OR值分彆為2.684和7.547。結論通過對外科重癥鑑護室VAP危險因素的研究分析，于製定科學的護理對策，以有效降低VAP的髮生率。
목적：분석외과중증감호실환자호흡궤상관성폐염（ventilator associated pneumonia，VAP）적위험인소，병제정침대성적호리대책。방법회고성분석2012년1-12월엄주시모삼급갑등의원외과중증감호실수치적104례궤계통기초과48 h환자적림상자료，병장환자분위VAP화비VAP조，선이단인소분석사선출유통계학의의적변량，재사용축보 Logistic 회귀분석학정VAP적현저독립위험인소，병실시침대성호리조시。결과단인소분석현시，궤계통기시간、입주외과중증감호실시간、기출질병、중심정맥치관、급진、삽관방식、수혈사、진정평분、무화흡입、혼미、격소、혈청백단백、상궤전48 h사용항생소、억산제등14항인소차이유통계학의의（P<0.05）；단다인소분석지유궤계통기시간、혼미진입회귀방정，시외과중증감호실 VAP적위험인소， OR치분별위2.684화7.547。결론통과대외과중증감호실VAP위험인소적연구분석，우제정과학적호리대책，이유효강저VAP적발생솔。
Objective To explore the risk factors of ventilator associated pneumonia (VAP) and to develop targeted nursing measures in surgical Intensive Care Unit (ICU). Methods A retrospective analysis was conducted with clinical data of 104 mechanically ventilated patients treated more than 48h in surgical ICU, and the patients were divided into VAP group and non-VAP group. Risk factors with statistical significance were first screened with univariate analysis, and independent risk factors for VAP were identified with stepwise logistic regression analysis, then appropriate nursing interventions based on independent risk factors were performed. Results Univariate analysis indicated that duration of mechanical ventilation, length of stay in surgical ICU, underlying diseases, PICC, emergency, intubation way, history of blood transfusion, OAAS score, coma, hormone, ALB, antibiotics 48h before ventilation and antacid were significant factors affecting VAP in surgical ICU ( P<0.05) but multiple-factor analysis showed that only duration of mechanical ventilation (OR=2.684) and coma (OR=7.547) entered into regression equation and were risk factors for VAP. Conclusion The study on VAP risk factors is beneficial to effective reducing of VAP incidence in surgical ICU.
