| 陈文森,刘娟,刘辉,宋燕波,陈华玉,王蓉,张玉萍,蒋伟,李慧芬,李松琴,张苏明,刘波,张翔,张卫红.前瞻性监测呼吸机相关事件:8个成人ICU的队列研究[J].Chinese journal of Epidemiology,2016,37(8):1148-1151 |
| 前瞻性监测呼吸机相关事件:8个成人ICU的队列研究 |
| Prospective evaluation on ventilator-associated events: a cohort study from eight intensive care units |
| Received:January 21, 2016 |
| DOI：10.3760/cma.j.issn.0254-6450.2016.08.019 |
| KeyWord: 呼吸机相关事件 灵敏度 特异度 |
| English Key Word: Ventilator associated events Sensitivity Specificity |
| FundProject:江苏省高校优势学科建设工程项目（JX10231801）；江苏省卫生厅预防医学课题（Y2013044） |
| Author Name | Affiliation | E-mail | | Chen Wensen | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Liu Juan | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Liu Hui | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Song Yanbo | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Chen Huayu | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Wang Rong | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Zhang Yuping | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Jiang Wei | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Li Huifen | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Li Songqin | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Zhang Suming | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Liu Bo | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Zhang Xiang | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | | | Zhang Weihong | The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China | metrischen@126.com |
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| Abstract: |
| 目的 前瞻性监测医院重症监护室（ICU）成年患者呼吸机相关事件（VAE）发生情况，探讨VAE与传统监测指标——呼吸机相关肺炎（VAP）的相关性。方法 以有创通气>48 h患者为监测队列，前瞻性分析某三甲综合教学医院2015年1月1日至3月31日8个ICU成年患者发生VAE［包括呼吸机相关并发症（VAC）、感染相关并发症（IVAC）和疑诊VAP（PVAP）］的情况。计算VAC相对于VAP的灵敏度和特异度。采用Kappa一致性检验判断，VAE与VAP的一致性。结果 该期间8个ICU共收入患者1 014人次，7 977个住院日。其中符合纳入标准197人次，合计3 152个机械通气日（VAC：1 214个机械通气日；非VAC：1 938个机械通气日）；VAC为46例次，其中IVAC 22例次（含有PVAP 8例次），相应发生率分别为14.59和6.98每千机械通气日。VAC患者ICU入住时间和机械通气时间均显著长于非VAC患者（均P<0.05）。VAC诊断VAP的灵敏度为36.92%，特异度为83.33%。结论 VAE诊断流程可以作为ICU可靠的监测方法用于机械通气患者目标监测，但VAC相对于VAP，其灵敏度和特异度均不高。实现自动监测依赖于信息系统的改进和数据采集的严格质量控制。 |
| English Abstract: |
| Objective The aim of this study was to prospectively investigate the incidence of ventilator associated events (VAEs) in intensive care units (ICUs) among adult patients, and to evaluate the correlation between VAEs and ventilator associated pneumonia (VAP). Methods A prospective 3-month cohort study (January 2015 to March 2015) was carried out. VAEs were divided into three groups:with ventilator-associated condition (VAC), with infection related ventilator- associated complication (IVAC) and with possible VAP (PVAP). Sensitivity and specificity of VAEs were evaluated and compared to the traditional VAP. Kappa test was applied to judge the consistency of VAC and VAP. Results During Jan. 2015 and Mar. 2015, 1 014 patients were admitted to 8 ICUs, with 7 977 patients per day. In total, 197 patients used the mechanical ventilation installation, with, a total number of 3 152 ventilator-days. Finally, 1 214 ventilation days in the VAC group and 1 938 ventilation days in the non-VAC group) that were available for final analysis. 46 VAC cases were identified including 22 classified as IVAC (14.59 and 6.98 per 1 000 ventilation days, respectively). Length of ICU stay and duration on mechanical ventilation for VAC patients were both significantly longer than those for non-VAC patients (P<0.05). Sensitivity and specificity of the VAC criteria for the detection of VAP were 36.92% and 83.33%, respectively. Conclusion The VAEs surveillance paradigms could be applied to monitor patients on the use of mechanical ventilation installation. However, sensitivity and specificity of VAC were under pool for the diagnosis of VAP. However, automatically surveillance programs was relied on the improvement of auto-information systems. |
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