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目的:通过研究急诊监护病房(EICU)机械通气相关性肺炎(VAP)的发病危险因素及病原学特点,为VAP防治提供流行病学资料,为制定和采取干预对策提供科学依据。方法:采用前瞻性队列研究,以我院EICU行气管插管或气管切开患者为对象作单因素和Logistic回归分析,筛选VAP发病的危险因素。结果:102例患者行机械通气,其中56例发生VAP,发生率54.9%,将17项变量行单因素分析显示,COPD病史、白蛋白<25g/L、连续使用抗生素>3d等11项因素有统计学意义。Logistic回归分析显示,VAP的独立发病危险因素有同时使用2种以上抗生素、重复气管插管、APACHEⅡ评分>15分、躯干平卧位、机械通气时间延长。VAP的病原菌为多重耐药菌。结论:EICU发生VAP是多种因素共同作用的结果,应采取综合性干预对策,以切实降低感染率,提高救治成功率。
Objective: To provide epidemiological data for prevention and treatment of VAP by studying the risk factors and etiological characteristics of mechanical ventilation-related pneumonia (VAP) in emergency unit (EICU) and to provide a scientific basis for the formulation and intervention measures. Methods: A prospective cohort study was conducted to investigate the risk factors for the pathogenesis of VAP by single factor and Logistic regression analysis in patients with tracheotomy or tracheotomy in our hospital. Results: Venous ventilation was performed in 102 patients, of which VAP occurred in 56 patients and the incidence rate was 54.9%. Univariate analysis of 17 variables showed 11 COPD patients with history of COPD, albumin <25g / L, continuous use of antibiotics> 3d Statistical significance. Logistic regression analysis showed that the independent risk factors of VAP were the simultaneous use of more than two antibiotics, repeated tracheal intubation, APACHE Ⅱ score> 15 points, trunk supine position, mechanical ventilation extended. VAP pathogens are multi-resistant bacteria. Conclusion: The occurrence of VAP in EICU is the result of the combination of many factors. Comprehensive intervention strategies should be taken to effectively reduce the infection rate and improve the success rate of treatment.