国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2012年
10期
721-726
,共6页
刘帅%潘速跃%姬仲%吴永明
劉帥%潘速躍%姬仲%吳永明
류수%반속약%희중%오영명
肺炎%加强医疗病房%神经系统疾病%危险因素
肺炎%加彊醫療病房%神經繫統疾病%危險因素
폐염%가강의료병방%신경계통질병%위험인소
Pneumonia%Intensive Care Units%Nervous System Diseases%Risk Factors
目的 探讨神经内科重症监护病房(neurological intensive care unit,NICU)内医院获得性肺炎(hospital-acquired pneumonia,HAP)的危险因素.方法 纳入2010年5月至2011年4月期间入住南方医院NICU≥48 h且年龄≥18岁的患者,回顾性调查其一般资料、入住NICU 24 h内最差格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分以及急性生理功能和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、是否发生HAP、在研究时间范围内是否存在某些基础疾病或症状、使用特定药物治疗或侵袭性操作等可能的危险因素,同时记录连续性医疗干预措施的持续时间,并对连续型变量进行量化分层.结果 共纳入243例患者,其中HAP 50例(20.6％).单变量分析显示,HAP组昏迷(44.0％对29.0％;x2=4.091,P=0.043)和APACHEⅡ评分≥15分(60.0％对38.9％x2=7.232,P=0.007)的比例显著高于非HAP组,两组间使用抗酸药(＜6 d:38.0％对19.7％;≥6 d:18.0％对25.9％;x2=7.521,P=0.023)、使用镇静药(＜2 d:30.0％对37.3％;≥2 d:46.0％对28.0％;x2=6.064,P=0.048)、使用血液制品(＜3 d:24.0％对9.8％;≥3 d:6.0％对7.3％;x2 =7.150,P=0.028)、气管插管(＜5 d:24.0％对10.9％;≥5 d:26.0％对15.5％;X2=10.698,P=0.005)、机械通气(＜4 d:6.0％对7.8％;≥4 d:30.0％对7.8％,x2=18.132,P=0.000)和留置鼻胃管(＜7 d:56.0％对37.3％;≥7 d:42.0％对44.6％;X2=10.410,P=0.005)存在显著性差异.多变量logistic回归分析显示,机械通气≥4 d[优势比(odds ratio,OR)6.481,95％可信区间(confidence interval,CI)2.522 ～ 16.654;P=0.000]、留置鼻胃管＜7 d(OR 12.504,95％ CI 1.614 ～ 96.869;P=0.016)和使用抗酸药＜6 d(OR 2.271,95％ CI 1.042 ～4.949;P=0.039)为NICU患者发生HAP的独立危险因素.结论 机械通气、留置鼻胃管和使用抗酸药为NICU患者发生HAP的独立危险因素,需采取有针对性的措施.
目的 探討神經內科重癥鑑護病房(neurological intensive care unit,NICU)內醫院穫得性肺炎(hospital-acquired pneumonia,HAP)的危險因素.方法 納入2010年5月至2011年4月期間入住南方醫院NICU≥48 h且年齡≥18歲的患者,迴顧性調查其一般資料、入住NICU 24 h內最差格拉斯哥昏迷量錶(Glasgow Coma Scale,GCS)評分以及急性生理功能和慢性健康狀況評分(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、是否髮生HAP、在研究時間範圍內是否存在某些基礎疾病或癥狀、使用特定藥物治療或侵襲性操作等可能的危險因素,同時記錄連續性醫療榦預措施的持續時間,併對連續型變量進行量化分層.結果 共納入243例患者,其中HAP 50例(20.6％).單變量分析顯示,HAP組昏迷(44.0％對29.0％;x2=4.091,P=0.043)和APACHEⅡ評分≥15分(60.0％對38.9％x2=7.232,P=0.007)的比例顯著高于非HAP組,兩組間使用抗痠藥(＜6 d:38.0％對19.7％;≥6 d:18.0％對25.9％;x2=7.521,P=0.023)、使用鎮靜藥(＜2 d:30.0％對37.3％;≥2 d:46.0％對28.0％;x2=6.064,P=0.048)、使用血液製品(＜3 d:24.0％對9.8％;≥3 d:6.0％對7.3％;x2 =7.150,P=0.028)、氣管插管(＜5 d:24.0％對10.9％;≥5 d:26.0％對15.5％;X2=10.698,P=0.005)、機械通氣(＜4 d:6.0％對7.8％;≥4 d:30.0％對7.8％,x2=18.132,P=0.000)和留置鼻胃管(＜7 d:56.0％對37.3％;≥7 d:42.0％對44.6％;X2=10.410,P=0.005)存在顯著性差異.多變量logistic迴歸分析顯示,機械通氣≥4 d[優勢比(odds ratio,OR)6.481,95％可信區間(confidence interval,CI)2.522 ～ 16.654;P=0.000]、留置鼻胃管＜7 d(OR 12.504,95％ CI 1.614 ～ 96.869;P=0.016)和使用抗痠藥＜6 d(OR 2.271,95％ CI 1.042 ～4.949;P=0.039)為NICU患者髮生HAP的獨立危險因素.結論 機械通氣、留置鼻胃管和使用抗痠藥為NICU患者髮生HAP的獨立危險因素,需採取有針對性的措施.
목적 탐토신경내과중증감호병방(neurological intensive care unit,NICU)내의원획득성폐염(hospital-acquired pneumonia,HAP)적위험인소.방법 납입2010년5월지2011년4월기간입주남방의원NICU≥48 h차년령≥18세적환자,회고성조사기일반자료、입주NICU 24 h내최차격랍사가혼미량표(Glasgow Coma Scale,GCS)평분이급급성생리공능화만성건강상황평분(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、시부발생HAP、재연구시간범위내시부존재모사기출질병혹증상、사용특정약물치료혹침습성조작등가능적위험인소,동시기록련속성의료간예조시적지속시간,병대련속형변량진행양화분층.결과 공납입243례환자,기중HAP 50례(20.6％).단변량분석현시,HAP조혼미(44.0％대29.0％;x2=4.091,P=0.043)화APACHEⅡ평분≥15분(60.0％대38.9％x2=7.232,P=0.007)적비례현저고우비HAP조,량조간사용항산약(＜6 d:38.0％대19.7％;≥6 d:18.0％대25.9％;x2=7.521,P=0.023)、사용진정약(＜2 d:30.0％대37.3％;≥2 d:46.0％대28.0％;x2=6.064,P=0.048)、사용혈액제품(＜3 d:24.0％대9.8％;≥3 d:6.0％대7.3％;x2 =7.150,P=0.028)、기관삽관(＜5 d:24.0％대10.9％;≥5 d:26.0％대15.5％;X2=10.698,P=0.005)、궤계통기(＜4 d:6.0％대7.8％;≥4 d:30.0％대7.8％,x2=18.132,P=0.000)화류치비위관(＜7 d:56.0％대37.3％;≥7 d:42.0％대44.6％;X2=10.410,P=0.005)존재현저성차이.다변량logistic회귀분석현시,궤계통기≥4 d[우세비(odds ratio,OR)6.481,95％가신구간(confidence interval,CI)2.522 ～ 16.654;P=0.000]、류치비위관＜7 d(OR 12.504,95％ CI 1.614 ～ 96.869;P=0.016)화사용항산약＜6 d(OR 2.271,95％ CI 1.042 ～4.949;P=0.039)위NICU환자발생HAP적독립위험인소.결론 궤계통기、류치비위관화사용항산약위NICU환자발생HAP적독립위험인소,수채취유침대성적조시.
Objective To investigate the risk factors for hospital-acquired pneumonia (HAP) in a neurological intensive care unit (NICU).Methods The patients aged ≥ 18 years admitted in NICU of Nanfang Hospital for ≥ 48 hours from May 2010 to April 2011 were enrolled.The possible risk factors,including the general information,the worst Glasgow Coma Scale (GCS) score,as well as Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores within 24 hours in NICU,whether the occurrence of HAP,whether with some underlying disease or symptoms within the time of study and using specific drug therapy or invasive procedures were investigated retrospectively.The duration of continuous medical interventions was recorded at the same time,and the continuous variables were quantified and stratified.Results A total of 243 patients were enrolled,and 50 (20.6％) of them developed HAP.Univariate analysis showed that the proportions of coma (44.0％ vs.29.0％ ;x2 =4.091,P =0.043) and APACHE Ⅱ score ≥ 15 (60.0％ vs.38.9％ ;x2 =7.232,P =0.007) in the HAP group were significantly higher than those in the non-HAP group.There were significant differences in using antacids (＜ 6 d: 38.0％ vs.19.7％ ; ≥ 6 d: 18.0％ vs.25.9％ ; x2 =7.521,P =0.023),sedatives (＜2 d: 30.0％ vs.37.3％ ; ≥2 d: 46.0％ vs.28.0％ ;x2 =6.064,P =0.048),blood products (＜3 d: 24.0％ vs.9.8％ ; ≥ 3 d: 6.0％ vs.7.3％ ; x2 =7.150,P =0.028),endotracheal intubation (＜ 5 d:24.0％ vs.10.9％ ; ≥ 5d: 26.0％ vs.15.5％ ; x2 =10.698,P =0.005),mechanical ventilation (＜ 4 d:6.0％ vs.7.8％ ; ≥ 4 d: 30.0％ vs.7.8％ ; x2=,P =0.000) and indwelling nasogastric tube (＜ 7 d:56.0％vs.37.3％ ; ≥7d: 42.0％ vs.44.6％ ;x2 =10.410,P =0.005) between the two groups.Multivariate logistic regression analysis showed that mechanical ventilation ≥ 4 d (odds ratio [OR] 6.481,95％ confidence interval [CI] 2.522-16.654; P=0.000),indwelling nasogastric tube ＜7 d (OR 12.504,95％ CI 1.614-96.869; P =0.016) and using antacids ＜ 6 d (OR 2.271,95％ CI 1.042-4.949; P =0.039) were the independent risk factors for HAP in NICU patients.Conclusions Mechanical ventilation,indwelling nasogastric tube and using antacids are the independent risk factors for HAP in NICU patients,and thus it needs to take targeted measures.
