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目的分析机械通气(MV)患者发生呼吸机相关性肺炎(VAP)的危险因素,探讨防治对策。方法前瞻性研究分析2004年1月至2006年6月入住本院综合性重症监护室(ICU)经口气管插管行机械通气患者共111例,并对随机给予持续声门下吸引(CASS)的56例、非吸引组55例患者的临床资料,进行以是否发生 VAP 为因变量的多因素 Logistic 回归分析。结果 111例患者中 VAP 发生率为56.76%,早发性 VAP 发生率为26.13%。吸引组 VAP 发生率,MV 5天内 VAP 发生率均低于非吸引组(P<0.01),发生时间晚于非吸引组(P<0.05)。Logistic 分析表明,VAP 组与非 VAP 组相比,在有无给予 CASS、留置胃管、A-PACHEⅡ评分及机械通气时间方面有显著差异(P<0.05)。结论不给予 CASS、留置胃管、APACHE 评分较高、机械通气时间较长是 VAP 发生的主要危险因素。应用 CASS 是防治 VAP 的有效措施之一。
Objective To analyze the risk factors of ventilator-associated pneumonia (VAP) in patients with mechanical ventilation (MV) and to explore the control strategies. Methods A prospective study was conducted to analyze 111 patients with mechanical ventilation undergoing oral intubation in our Intensive Care Unit (ICU) from January 2004 to June 2006. The patients undergoing continuous subglottic suction (CASS) 56 cases of non-attracting group of 55 patients with clinical data, whether or not VAP as a dependent variable multivariate Logistic regression analysis. Results The incidence of VAP in 111 patients was 56.76%, the incidence of VAP was 26.13%. The incidence of VAP in the aspiration group and VAP in the 5 days of MV were lower than those in the non-aspiration group (P <0.01) and later than those in the non-aspiration group (P <0.05). Logistic analysis showed that there were significant differences (P <0.05) in CASS, gastric tube placement, A-PACHE II score and mechanical ventilation time between VAP group and non-VAP group. Conclusions CASS, indwelling gastric tube, higher APACHE score and longer duration of mechanical ventilation are the main risk factors for VAP. CASS is one of the effective measures to prevent and control VAP.