CAJ | 학술논문

回顾性分析2010年1月-2013年12月机械通气时间超过48 h的178例患者的临床资料,其中呼吸机相关性气管支气管炎(VAT) 56例.对患者年龄、性别、高血压、糖尿病、BMI、机械通气时间、气管插管方式、头部是否抬高30 ～45°、是否使用质子泵抑制剂、是否预防性使用抗生素、格拉斯哥昏迷评分(GCS)和急性生理学与慢性健康状况评分(APACHEⅡ)等相关因素进行单因素logistic回归分析及多因素logistic回归分析.单因素logistic分析发现性别、血压、BMI、气管插管方式及是否使用质子泵抑制剂对VAT的影响无统计学意义(P＞0.05),而年龄、血糖、机械通气时间、是否头部抬高、是否预防性使用抗生素、GCS评分和APACHEⅡ评分7个指标与VAT相关性有统计学意义(P＜0.05),多因素logistic回归分析发现,影响VAT危险因素为机械通气时间(OR =4.072,95％CI:2.036 ～8.146)、GCS评分[2.198(1.155 ～4.184)]、年龄[2.128(1.119 ～4.046)]、APACHEⅡ评分[2.109(1.084～4.104)]、头部是否抬高30 ～45°[0.488(0.243～0.979)].
회고성분석2010년1월-2013년12월궤계통기시간초과48 h적178례환자적림상자료,기중호흡궤상관성기관지기관염(VAT) 56례.대환자년령、성별、고혈압、당뇨병、BMI、궤계통기시간、기관삽관방식、두부시부태고30 ～45°、시부사용질자빙억제제、시부예방성사용항생소、격랍사가혼미평분(GCS)화급성생이학여만성건강상황평분(APACHEⅡ)등상관인소진행단인소logistic회귀분석급다인소logistic회귀분석.단인소logistic분석발현성별、혈압、BMI、기관삽관방식급시부사용질자빙억제제대VAT적영향무통계학의의(P＞0.05),이년령、혈당、궤계통기시간、시부두부태고、시부예방성사용항생소、GCS평분화APACHEⅡ평분7개지표여VAT상관성유통계학의의(P＜0.05),다인소logistic회귀분석발현,영향VAT위험인소위궤계통기시간(OR =4.072,95％CI:2.036 ～8.146)、GCS평분[2.198(1.155 ～4.184)]、년령[2.128(1.119 ～4.046)]、APACHEⅡ평분[2.109(1.084～4.104)]、두부시부태고30 ～45°[0.488(0.243～0.979)].
A total of 178 patients with the time of mechanical ventilation beyond 48 hours in the second affiliated hospital of Wenzhou medical college from January 2010 to December 2013 were enrolled in this study,and there were fifty-six patients with ventilator-associated tracheobronchitis (VAT).The associated factors included age,sex,blood pressure,blood glucose,BMI,the time of mechanical ventilation,tracheal intubation methods,raise head to 30-45°,proton pump inhibitors (PPI),prophylactic antibiotic treatment,glasgow coma scale (GCS),acute physiology and chronic health evaluation (APECHE) Ⅱ score.The related factors of VAT were evaluated by using univariate logistical regression analysis,and the statistical significant variables were analyzed by using multivariate logistical regression analysis.By using univariate logistical regression analysis age,blood glucose,the time of mechanical ventilation,raise head to 30-45°,prophylactic antibiotic treatment,GCS and APECHE Ⅱ score were the important factors of VAT (P ＜ 0.05),but sex,blood pressure,BMI,tracheal intubation methods and PPI were insignificant related to VAT(P ＞ 0.05).By using multivariate logistical regression analysis the time of mechanical ventilation (OR =4.072,95％ CI 2.036-8.146),GCS[2.198(1.155-4.184)],age[2.128 (1.119-4.046)],APECHE Ⅱ score [2.109 (1.084-4.104)] and raise head to 30-45 ° [0.488 (0.243-0.979)] were associated independently with the VAT.The time of mechanical ventilation,GCS,age over 60 years,APECHE Ⅱ score and raise head to 30-45°were the independent factors associated with VAT.