重症手足口病呼吸机相关性肺炎危险因素分析.docVIP

PAGE PAGE 4 重症手足口病呼吸机相关性肺炎危险因素分析 摘要：目的 探讨重症手足口病呼吸机相关性肺炎（VAP）发生的危险因素，并进行分析。方法 收集江西省宜春市人民医院2009年3月至2011年10月间儿科PICU收治的上机时间大于48h的重症手足口病患儿病例资料共142例进行回顾性分析，按有无合并VAP分为两组：发生VAP的64例为VAP组，未发生VAP的78例为对照组。以年龄、性别、机械通气时间等因素为预想危险因素进行单因素及多因素分析，总结各危险因素与VAP的相关性。结果 重症手足口病上机患儿VAP的发生率为45.1%，病死率为12.5%。多因素Logistic回归分析显示，各危险因素在发生VAP中的作用大小顺序依次为：再插管、机械通气时间、频繁气管内吸引、合并肺出血、呼吸道免疫功能低下，预防性使用抗生素为保护性因素。结论 重症手足口病上机患儿VAP发生率较高，危险因素众多，采取针对性防治措施可能是控制VAP的最佳方法。 关键词：重症手足口病 ；呼吸相关性肺炎；危险因素 High risk factors analysis of ventilator-associated pneumonia in serious Hand foot and mouth disease(HFMD) patients [Abstract] Objective To explore high risk factors of VAP in serious foot and mouth disease(HFMD) patients. Methods A retrospective study was conducted in 142 serious HFMD patients who had hours of mechanical ventilation≥48h. Among the patients, mechanical ventilation HFMD patients who suffered VAP were included in a obsevation group(n=64),and non-VAP HFMD patients were in a control group(n=78). Case-control method, single-fastor analysis with Chi-square test and multiple logistic regression were performed to detremine risk factors such as age、sex、ventilation hour,and so on .Results The incidence of VAP in serious HFMD patients who used respirators was 45.1%,and the death rate was 12.5%.By multiple logistic regression analysis, the risk factors in the role of VAP happened for the order size are reintuba-tion,duration of mechanical ventilation, frequently airway suctioning, with pulmonary hemorrhage, short of respiratory immune function .Use of antibiotic was a protection factor in preventing. Conclusion Incidence of VAP in HFMD is high,with many risk factors,and a specific prevention and cure treatment may be the best way to manage VAP. Key words: serious Hand foot and mouth disease(HFMD); ventilator-associated pneumonia(VAP); risk factor 机械通气是抢救危重患者生命的重要措施，能为危重患者原发病的治疗赢得时间，但也会为通气并发症的出现提供机会，最常见的并发症就是呼吸机相关性肺炎（VAP）。手足口病近年来出现新的流行病学变化，危重病例明显增多，机械通气治疗在重症手足口病患儿的抢救中起到了非常关键的作用，但若并发VAP，刚可导致拨管困难、延长住院时间及增加医疗费用参