临床相关因素对呼吸机相关性肺炎预后的影响

周畔; 何红; 刘敬东; 吴晓虹

Abstract

周畔,何红,刘敬东,吴晓虹.临床相关因素对呼吸机相关性肺炎预后的影响[J].Chinese journal of Epidemiology,2003,24(3):216-219

临床相关因素对呼吸机相关性肺炎预后的影响

Impact clinically related factors on the outcomes of ventilator-associated pneumonia

Received:July 08, 2002

DOI：

KeyWord: 肺通气机肺炎病原菌病死率相关因素

English Key Word: Pulmonary ventilators Pneumonia Bacteria Mortality Relative factors

FundProject:

Author Name	Affiliation
ZHOU Pan	Department of Pulmonary, Sir Run Run Shaw Hospital, Zhejiang, Hangzhou 310016, China
HE Hong	Department of Pulmonary, Sir Run Run Shaw Hospital, Zhejiang, Hangzhou 310016, China
LIU Jingdong	Department of Pulmonary, Sir Run Run Shaw Hospital, Zhejiang, Hangzhou 310016, China
WU Xiaohong	浙江大学医学院附属第一医院呼吸内科

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Abstract:

目的确定临床相关因素对呼吸机相关性肺炎(VAP)预后的影响。方法前瞻性临床研究120例连续性发生的VAP。病原学诊断是根据气管内吸出物、防污染毛刷和肺泡灌洗采集标本定量培养结果。用软件统计包(SPSS)中的逐步logistic回归模型分析影响VAP预后的流行病学和临床相关因素。结果VAP患者总病死率为17%(20120),与VAP相关病死率为14%(17120)。单因素分析中年龄超过45岁、致命性基础疾病、先前使用抗生素、使用激素、住院日期超过9天、休克、有慢性阻塞性肺病史与VAP病死率有显著相关性。进一步逐步logistic回归分析显示只有先前使用抗生素(P<0.0001,OR=9.2)是影响VAP患者病死率的独立相关因素。将VAP病原菌作为一项自变量,重复作逐步logistic回归分析,先前使用抗生素因素被“高危”病原菌因素所替代。结论VAP患者先前使用抗生素与病死率增高密切相关主要是由于抗生素的使用导致耐药菌产生。因此为减少VAP患者死亡危险性,应严格管理机械通气患者抗生素的使用

English Abstract:

Objective To define the influence clinically related factors in the prognosis of ventilated pneumonia (VAP). Methods A prospective clinical study involving 120 patients with VAP was carried ont. Etiologic diagnosis was established under quantitative culture of endotracheal aspiration, a protected specimen brush and bronchoalveolar lavage. Prognostic using a statistical software package (SPSS) factors were examined for univariate and multivariate analyses. Results Case fatality directly related to the infection was 14 percent. From univariate analysis, variables that significantly associated with attributable mortality were age older than 45 years,use of corticosteroids,presence of shock, in-hospital days of VAP over as follows 9, antecedent chronic obstructive pulmonary disease,and a prior antibiotic use.Through step-forward logistic regression analysis, only prior antibiotic use ( P 0.000 1, OR= 9.2) was defined as a significant factor influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation. Conclusions Distribution of microorganisms that responsible for VAP showen different in patients who had received prior antimicrobial therapy, and this factor caused higher mortality rate. We suggested a restrictive antibiotic use strategy among mechanically ventilated patients to reduce the risk of death frome VAP.

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