CAJ | 학술논문

目的：探讨急诊呼吸机辅助通气相关性肺炎（ VAP）的危险因素及预防策略。方法选取2009年10月至2012年10月于福建医科大学附属龙岩第一医院呼吸内科治疗的重症患者50例，均采取呼吸机辅助通气治疗，再按其是否发生VAP分为VAP组20例和非VAP组30例，分析性别、年龄、机械通气时间、昏迷与否、ICU观察天数、抗生素联合使用情况、胃内容物吸入与否以及 H2受体拮抗剂使用与否与VAP的相关性。结果机械通气时间＞3 d、ICU观察天数＞7 d、昏迷、联合应用抗生素种类＞2种等因素均对VAP的发生造成影响（P＜0．05）；Logistic回归分析发现机械通气时间≥3 d（OR＝2．387）、ICU观察天数＞7 d（OR＝2．142）、联合应用抗生素种类≤2种（OR＝1．669）、胃内容物吸入（OR＝1．779）、H2受体拮抗剂（OR ＝2．006）5个变量是 VAP的危险因素。结论机械通气时间等因素是 VAP 的相关危险因素，临床上联合应用静脉注射抗生素及吸入抗生素可提高VAP患者的疗效。
목적：탐토급진호흡궤보조통기상관성폐염（ VAP）적위험인소급예방책략。방법선취2009년10월지2012년10월우복건의과대학부속룡암제일의원호흡내과치료적중증환자50례，균채취호흡궤보조통기치료，재안기시부발생VAP분위VAP조20례화비VAP조30례，분석성별、년령、궤계통기시간、혼미여부、ICU관찰천수、항생소연합사용정황、위내용물흡입여부이급 H2수체길항제사용여부여VAP적상관성。결과궤계통기시간＞3 d、ICU관찰천수＞7 d、혼미、연합응용항생소충류＞2충등인소균대VAP적발생조성영향（P＜0．05）；Logistic회귀분석발현궤계통기시간≥3 d（OR＝2．387）、ICU관찰천수＞7 d（OR＝2．142）、연합응용항생소충류≤2충（OR＝1．669）、위내용물흡입（OR＝1．779）、H2수체길항제（OR ＝2．006）5개변량시 VAP적위험인소。결론궤계통기시간등인소시 VAP 적상관위험인소，림상상연합응용정맥주사항생소급흡입항생소가제고VAP환자적료효。
Objective To investigate the risk factors of emergency ventilator-associated pneumonia ( VAP) and its prevention.Methods A total of 50 cases of critically ill patients treated in Department of Respiratory Medicine of Longyan First Affiliated Hospital of Fujian Medical University from Oct .2009 to Oct. 2012 were all given mechanical ventilation therapy , and divided into VAP group ( n =20 ) and non-VAP group(n=30).Parameters of gender,age,duration of mechanical ventilation,coma,observation days in ICU, combined application of antibiotics,inhalation of gastric contents,application of H2 receptor antagonist were analyzed to identify the risk factors of VAP.Results Duration of mechanical ventilation >3 d,observation days in ICU>7 d,coma,combined application of antibiotics >2 kinds were risk factors of VAP(P<0.05);results of logistic regression analysis showed that duration of mechanical ventilation≥3 d (OR =2.387), observation days in ICU>7 d(OR=2.142),combined application of antibiotics≤2 kinds(OR =1.669), inhalation of gastric contents(OR=1.779),H2 receptor antagonist (OR=2.006) had close correlation with VAP secondary pulmonary fungal infection.Conclusion Duration of mechanical ventilation and some other factors are the risk factors of ventilator-associated pneumonia,combined clinical application of intravenous an-tibiotics and inhaled antibiotics can improve the curative effect of VAP .