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呼吸机相关感染并发症危险因素分析及病原菌分布研究

Risk factors and distribution of pathogenic bacteria of ventilator-associated infection complications
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摘要 目的研究重症监护病房(ICU)呼吸机相关事件第2个等级——呼吸机相关感染并发症(IVAC)的危险因素及病原菌分布,以期为IVAC的防治提供流行病学资料,为制定预防控制IVAC的措施提供科学依据。方法选取2023年1月至2024年1月徐州医科大学附属医院重症医学科和急诊重症监护室2个综合ICU气管插管或气管切开行有创机械通气大于或等于4 d的成年患者684例作为研究对象,采用前瞻性队列研究,进行单因素和多因素logistic回归模型分析,筛选发生IVAC的可能危险因素。结果684例患者中发生呼吸机相关事件62例,其中IVAC 33例,包括单纯IVAC 15例和疑诊肺炎18例,IVAC发生率为4.82%(33/684);5.15每千机械通气日,病死率为30.30%(10/33)。IVAC患者建立人工气道至机械通气第4天昏迷、平均每天液体正性平衡大于或等于50 mL、平均每天胃潴留大于或等于200 mL、床头未抬高时间大于或等于4 d,以及机械通气第1~4天应用镇静剂、应用肌松药物比例均明显大于非IVAC患者,差异均有统计学意义(P<0.05)。建立人工气道至机械通气第4天平均每天液体正性平衡大于或等于50 mL、床头未抬高时间大于或等于4 d、平均每天胃潴留大于或等于200 mL均是IVAC的独立危险因素(相对危险度=22.95、17.83、9.46)。结论IVAC的发生是多因素综合作用的结果,应采取有效的集束化护理措施以降低IVAC发生率,从而降低呼吸机相关并发症发生率。 Objective To provide epidemiological data for the prevention and control of ventilator-associated event(VAE),and to provide a scientific basis for the formulation of measures to prevent and control VAE by studying the risk factors and pathogen distribution of ventilator-associated infection complications(IVAC),the second grade of VAE in intensive care unit(ICU).Methods A prospective cohort study was conducted on 684 adult patients who underwent invasive mechanical ventilation for 4 days or more during tracheal intubation or tracheotomy in the Intensive Care Unit of Xuzhou Medical University Affiliated Hospital and EICU from January 2023 to January 2024.Univariate and multivariate logistic regression models were used to screen for possible risk factors for IVAC.Results Among 684 patients,62 cases of ventilator-associated events occurred,including 33 cases of IVAC,including 15 cases of simple IVAC and 18 cases of suspected pneumonia.The incidence of IVAC was 4.82%(33/684);The mortality rate was 30.30%(10/33)per thousand days of mechanical ventilation.IVAC patients were comatose from the establishment of artificial airway to the fourth day of mechanical ventilation,the average daily positive fluid balance was greater than or equal to 50 mL,the average daily gastric retention was greater than or equal to 200 mL,the bed head was not raised for more than or equal to 4 days,and the proportion of sedatives and muscle relaxants used from the fourth day of mechanical ventilation was significantly higher than that of non IVAC patients,with statistically significant differences(P<0.05).From the establishment of artificial airway to the fourth day of mechanical ventilation,the average daily positive fluid balance is greater than or equal to 50 mL,the bed head is not raised for more than or equal to 4 days,and the average daily gastric retention is greater than or equal to 200 mL,which are independent risk factors for IVAC,with statistically significant differences(relative risk=22.95,17.83,9.46).Conclusion The occurrence of IVAC is a comprehensive result of many factors.Effective bundles of Care should be taken to reduce IVAC and reduce the incidence of ventilator-associated complications.
作者 刘纪 张生雷 茅一萍 LIU Ji;ZHANG Shenglei;MAO Yiping(Nursing Department,Xuzhou Higher Vocational School of Medicine,Xuzhou,Jiangsu 221116,China;Department of Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China;Department of Infection Management,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)
出处 《现代医药卫生》 2024年第23期4065-4070,共6页 Journal of Modern Medicine & Health
基金 江苏省徐州医药高等职业学校校级自然科学基金项目(2022ZZX03)。
关键词 呼吸机相关事件 呼吸机相关感染并发症 危险因素 病原菌 Ventilator-associated events Ventilator-associated infection complications Risk factors Pathogenic bacteria

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