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目的 探讨先天性心脏病 (先心病 )病儿术后通气相关性肺炎 (VAP)的危险因素。方法 回顾分析 6 2例先心病术后机械通气≥ 3d病儿VAP的发生与相关危险因素间的关系。结果 该组病儿均痊愈出院 ,发生VAP 39例 ;VAP发生于术后 (4 79± 2 81)d ,术后 (5 6 7± 2 90 )d痰培养阳性 ;痰病原学阳性检出率为 2 8 2 1% (11 39例 ) ,培养细菌菌株 15株 ,致病菌均为革兰阴性菌 ;经logistic回归分析显示 ,VAP的发生与术前反复肺部炎症、低免疫球蛋白水平、术后使用H2 受体阻滞剂间的相关性差异有显著性 (P值分别为 0 0 0 0 1、0 0 0 5 9和 0 0 0 0 7) ,回归方程式 :R =EXP(βi)Xi+ε,回归系数分别为 1 16、0 5 9、0 83;经非参数检验显示 ,VAP与机械通气时间有关 (P <0 0 0 1)。结论 术前反复肺炎、免疫功能低下、术后机械通气时间长、使用H2 受体阻滞剂是VAP发生的重要因素。
Objective To investigate the risk factors of postoperative ventilator-associated pneumonia (VAP) in children with congenital heart disease (CHD). Methods We retrospectively analyzed the relationship between the occurrence of VAP and related risk factors in 62 children with mechanical ventilation ≥ 3d sickness after congenital heart disease. Results All the patients in this group were cured and discharged. VAP occurred in 39 cases; VAP occurred in 4 79 ± 2 81 days after operation and was positive in sputum (56 ± 2 90 days) after operation. The positive rate of sputum etiology (1 392 cases), 15 bacterial strains were cultured and the pathogenic bacteria were all Gram-negative bacteria. The logistic regression analysis showed that the occurrence of VAP was associated with repeated lung inflammation and low immunoglobulin levels (P values were 0 0 0 0 0 0 0 0 5 9 and 0 0 0 0 7, respectively). The regression equation was: R = EXP (βi ) Xi + ε, the regression coefficients were 1 16,0 5 9,0 83 respectively. The nonparametric test showed that VAP was related to the duration of mechanical ventilation (P 0 01). Conclusions Preoperative pneumonia, immunocompromise and mechanical ventilation for a long time, the use of H2 receptor blocker is an important factor in the occurrence of VAP.