| 马萍萍,章左艳,唐雯琦,钱海泳,李颖川.ICU呼吸机相关性肺炎患者炎性因子水平与病原学特征及危险因素分析[J].,2021,(7):1244-1247 |
| ICU呼吸机相关性肺炎患者炎性因子水平与病原学特征及危险因素分析 |
| Analysis of Levels of Inflammatory Factors, Etiological Characteristics and Risk Factors in ICU Patients with Ventilator-associated Pneumonia |
| 投稿时间：2020-09-21 修订日期：2020-10-17 |
| DOI：10.13241/j.cnki.pmb.2021.07.009 |
| 中文关键词: 重症监护室 呼吸机相关性肺炎 炎性因子 病原学特征 危险因素 |
| 英文关键词: Intensive care unit Ventilator-associated pneumonia Inflammatory factors Etiological characteristics Risk factors |
| 基金项目:上海市卫生和计划生育委员会科研项目（20144Y0235）；上海交通大学附属第六人民医院院级科学研究基金项目（院内-2151） |
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| 中文摘要: |
| 摘要 目的：研究重症监护室（ICU）呼吸机相关性肺炎（VAP）患者炎性因子水平与病原学特征及危险因素。方法：将从2017年1月～2019年12月，于我院ICU接受治疗的120例患者纳入研究。将其按照是否发生VAP分成VAP组48例与无VAP组72例。比较两组炎性因子水平，分析VAP患者的病原菌分布情况，分析ICU患者发生VAP的危险因素。结果：VAP组肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）及C反应蛋白（CRP）水平均高于无VAP组（均P＜0.05）。48例VAP患者共分离得到病原菌76株，按照占比从高到低的顺序依次为铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、大肠埃希菌、凝血酶阴性葡萄球菌、真菌，占比分别为22.37%、18.42%、17.11%、14.47%、13.16%、7.89%、6.58%。经单因素分析发现：ICU患者发生VAP与机械通气时间、抗菌药物联用以及留置胃管有关（均P＜0.05），与年龄、性别无关（均P＞0.05）。经多因素Logistic回归分析发现：机械通气时间≥7 d、抗菌药物联用、留置胃管均是ICU患者发生VAP的危险因素（P＜0.05）。结论：VAP患者的炎性因子水平存在显著升高的情况，且其病原菌以铜绿假单胞菌、鲍氏不动杆菌以及金黄色葡萄球菌等为主。此外，机械通气时间、抗菌药物联用以及留置胃管均与VAP的发生关系密切，值得临床重点关注。 |
| 英文摘要: |
| ABSTRACT Objective: To study the levels of inflammatory factors, etiological characteristics and risk factors in intensive care unit (ICU) patients with ventilators associated pneumonia (VAP). Methods: From January 2017 to December 2019, 120 patients receiving treatment in the ICU of our hospital were included in the study. The patients were divided into 48 cases in the VAP group and 72 cases in the non-VAP group according to whether or not VAP occurred. The levels of inflammatory factors in the two groups were compared, and the distribution of pathogenic bacteria in patients with VAP was analyzed. Multivariate Logistic regression was used to analyze the risk factors of VAP in ICU patients. Results: The levels of tumor necrosis factor-α (TNF-α), procalcitonin (PCT) and C-reactive protein (CRP) in VAP group were higher than those in non-VAP group (all P＜0.05). A total of 76 strains of pathogenic bacteria in 48 VAP patients were pseudomonas aeruginosa, acinetobacter baumannii, staphylococcus aureus, klebsiella pneumoniae, escherichia coli, thrombin negative staphylococcus and fungi in the order of proportion from high to low, accounting for 22.37%, 18.42%, 17.11%, 14.47%, 13.16%, 7.89% and 6.58% respectively. Single factor analysis analysis showed that the occurrence of VAP in ICU patients were related to mechanical ventilation time, combined use of antibiotics and indwelling of gastric tube (all P<0.05), and were not related to age and gender (all P>0.05). Multivariate Logistic regression analysis showed that: mechanical ventilation time ≥7 d, combined use of antimicrobial agents and indwelling gastric tube were all independent risk factors for VAP in ICU patients (all OR>1, P<0.05). Conclusion: The levels of inflammatory factors in VAP patients are significantly elevated, and the pathogenic bacteria are mainly pseudomonas aeruginosa, acinetobacter baumannii and staphylococcus aureus. In addition, the mechanical ventilation time, combined use of antimicrobial agents and indwelling gastric tube are closely related to the occurrence of VAP, which is worthy of clinical attention. |
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