| 摘要: |
| 目的:探讨新生儿呼吸机相关性肺炎(VAP)的短期预后,并分析影响预后的危险因素。方法:回顾性分析我院新生儿科重症监护室(NICU)2013年1月至2016年1月应用有创呼吸机辅助呼吸合并VAP的新生儿47例,选择同期住院且基本情况类似的未合并VAP的新生儿51例作为对照组,分析致病菌感染情况和短期预后,应用多元Logistic回归分析28 d与病死率相关的危险因素,应用受试者工作特征性曲线(ROC)评估危险因素的阈值。结果:入选的98 例新生儿中,男63例,女35例,平均胎龄(36.7±3.3)周,两组患儿的一般资料比较差异无统计学意义(P>0.05),但呼吸频率、心率、CRP、PCT、简化临床肺部感染评分(CPIS)比较差异有统计学意义(P<0.05)。病原菌主要为革兰阴性杆菌,且多为耐药菌。随访28 d 时,两组的住院时间、机械通气时间、病死率比较差异均有统计学意义(P<0.05)。胎龄、机械通气时间、PCT和简化CPIS为合并VAP的新生儿死亡的独立危险因素。胎龄≤33周、机械通气时间≥4 d、PCT≥2.0 μg/L和简化CPIS≥6为相关危险因素的ROC阈值。结论:VAP新生儿多合并耐药菌感
染,短期预后差,28 d病死率显著增加。胎龄小、机械通气时间长、PCT水平和CPIS评分高为短期死亡的独立危险因素。 |
| 关键词: 呼吸机相关肺炎 新生儿 病原菌 危险因素 预后 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2017.05.011 |
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| 基金项目: |
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| Pathogenic Bacteria, Prognosis and Risk Factors of Ventilator-Associated Pneumonia in Neonates |
| Liu Ying, Zhang Aiping |
| (Rongcheng People’s Hospital of Baoding, Hebei Baoding 071700, China) |
| Abstract: |
| Objective: To evaluate the prognosis and risk factors of ventilator-associated pneumonia (VAP) in NICU. Methods: A total of 47 neonates with VAP in our hospital from January 2013 to January 2016 were involved in VAP group and 51 neonates without VAP were involved in control group. The pathogenic bacteria and prognosis between two groups were compared. Furthermore, we used the Logistic regression to evaluate the risk factors related to fatality rate in 28 days. Results: Of the 98 neonates enrolled, there were 63 males and 35 females. The mean gestational age was (36.7±3.3) weeks. Basic clinical characteristics were similar between groups (P>0.05). However, rate of respiration, heart rate, C-reactive protein, PCT and CPIS were markedly different between the groups (P<0.05). Gram negative bacilli were the main pathogenic bacteria (mostly drug resistant bacteria). At 28-day follow-up, there were significant differences in hospitalization, duration of mechanical ventilation and fatality rate in two groups (P<0.05). Gestational age, duration of ventilation, PCT, CPIS were risk factors for mortality. The thresholds were Gestational age ≤33 weeks, duration of ventilation ≥4 days,PCT≥2.0 μg/L, CPIS≥6. Conclusion: VAP is associated with significantly increased risk of morbidity and mortality. Small gestational age, long ventilation duration, high PCT level and CPIS are risk factors for mortality. |
| Key words: ventilator-associated pneumonia neonate pathogenic bacteria risk factor prognosis |
