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目的探讨ICU患者呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的影响因素,为优化预防呼吸机相关性肺炎集束化策略(ventilator care bundle,VCB)提供证据。方法采用多因素Logistic回归分析法对我院中心ICU 2013年1-12月接受机械通气治疗的204例患者的VAP影响因素进行分析。结果 204例患者中35例发生VAP,发病率为17.16%。VAP影响因素的多因素分析结果显示:VCB未完全依从(OR=9.600,95%CI为1.060~86.935)、无持续声门下吸引(OR=9.197,95%CI为2.035~41.566)、呼吸机管理失效(OR=7.426,95%CI为1.044~52.798)、气管切开(OR=5.593,95%CI为1.420~22.031)、吸烟史(OR=4.936,95%CI为1.606~15.174)、年龄≥60岁(OR=4.334,95%CI为1.320~14.236)、肠内营养(OR=0.218,95%CI为0.061~0.779)对VAP的发生有显著影响。结论 VCB未完全依从、无持续声门下吸引、呼吸机管理失效、气管切开、吸烟史、年龄≥60岁是机械通气ICU患者的风险因素,肠内营养是保护因素。影响ICU患者VAP发病率的因素多源且复杂,应采取针对性措施,严密监控,加强集束化护理,以降低VAP的发生。
Objective To investigate the influencing factors of ventilator-associated pneumonia (VAP) in patients with ICU and to provide evidence for the optimization of ventilator-care bundle (VCB) in prevention of ventilator-associated pneumonia. Methods The multivariate logistic regression analysis was used to analyze the influencing factors of VAP in 204 patients who underwent mechanical ventilation between January 2013 and January 2013 in our center. Results Of the 204 patients, 35 cases developed VAP, the incidence rate was 17.16%. Multivariate analysis of VAP influencing factors showed that VCB was not completely complied with (OR = 9.600, 95% CI: 1.060-86.935), no sustained subglottic suction (OR = 9.197, 95% CI: 2.035-41.566) (OR = 4.926, 95% CI: 1.044-52.798), tracheotomy (OR = 5.593, 95% CI: 1.420-22.031), smoking history 60 years old (OR = 4.334, 95% CI 1.320 ~ 14.236), enteral nutrition (OR = 0.218, 95% CI 0.061 ~ 0.779) had a significant effect on the occurrence of VAP. CONCLUSIONS: VCB is not completely complied with, with no sustained subglottic suction, failure of ventilator management, tracheotomy, smoking history, and age ≥60 years are risk factors for ICU patients with mechanical ventilation. Enteral nutrition is a protective factor. The factors influencing the incidence of VAP in patients with ICU are multi-source and complex. Targeted measures should be taken to monitor and strengthen the intensive care so as to reduce the occurrence of VAP.