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[1]赵勍,贺晓春,何婧,等.儿童重症监护病房发生呼吸机相关性肺炎的危险因素分析[J].医学研究与战创伤救治(原医学研究生学报),2022,24(4):377-381.[doi:10.3969/j.issn.1672-271X.2022.04.009]
　ZHAO Qing,HE Xiao-chun,HE Jing,et al.Analysis of risk factors for ventilator-associated pneumonia in pediatric intensive care unit[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(4):377-381.[doi:10.3969/j.issn.1672-271X.2022.04.009]
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儿童重症监护病房发生呼吸机相关性肺炎的危险因素分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年4期
页码:
377-381
栏目:
临床研究
出版日期:
2022-08-30

文章信息/Info

Title:
Analysis of risk factors for ventilator-associated pneumonia in pediatric intensive care unit
作者:
赵勍; 贺晓春; 何婧; 刘章英; 冯飞; 谢娟
作者单位：610045成都，四川省妇幼保健院儿童重症医学专科(赵勍、贺晓春、何婧、刘章英、冯飞、谢娟)
Author(s):
ZHAO Qing;  HE Xiao-chun;  HE Jing;  LIU Zhang-ying;  FENG Fei;  XIE Juan
(Department of Children’s Intensive Medicine College Sichuan Maternal and Child Health Care Hospital, Chengdu 610045, Sichuan,China)
关键词:
儿童重症; 呼吸机相关性肺炎; 危险因素; 多因素分析
Keywords:
children with severe complications;  ventilator-associated pneumonia;  risk factors;  multivariate Analysis
分类号:
R720.597
DOI:
10.3969/j.issn.1672-271X.2022.04.009
文献标志码:
A
摘要:
目的探讨儿童重症监护病房(PICU)发生呼吸机相关性肺炎(VAP)的危险因素。方法选择2018年1月至2021年8月在四川省妇幼保健院PICU行呼吸机置管治疗的196例患儿。收集可能影响PICU患儿出现VAP的因素，根据有无VAP将患儿分为2组，比较上述各因素，并采用多因素Logistic回归分析评估各因素对PICU患儿发生VAP的综合作用。结果196例PICU患儿中共有23例（11.73%）发生VAP。23例VAP患儿中共分离出病原菌31株，其中以革兰阴性菌为主，占58.06%，革兰阳性菌占32.26%，真菌占9.68%。单因素分析基础上行多因素Logistic回归分析结果显示：机械通气时间＞3 d（OR=1.694，95%CI=1.204~2.382）、插管次数＞1次（OR=1.404，95%CI=1.010~1.951）、使用糖皮质激素（OR=1.490，95%CI=1.039~2.138）、使用质子泵抑制剂（OR=1.452，95%CI=1.112~1.896）、血pH升高（OR=1.445，95%CI=1.066~1.958）、血糖升高（OR=1.533，95%CI=1.116~2.105）、血浆白蛋白下降（OR=1.441，95%CI=1.036~2.002）、25羟维生素D下降（OR=1.530，95%CI=1.073~2.181）为PICU患儿出现VAP的危险因素（P<0.05）。根据多因素分析结果预测值作ROC曲线显示，所获得的Logistic模型对PICU患儿VAP预测的AUC为0.840，95%CI为0.784~0.896。结论PICU患儿VAP主要以感染革兰阴性菌为主，VAP的发生与患儿的血浆白蛋白水平、25羟维生素D水平、机械通气时间等因素有关，临床上可根据上述因素进行针对性干预。
Abstract:
ObjectiveTo investigate the risk factors of ventilator-associated pneumonia (VAP) in the pediatric intensive care unit (PICU).Methods196 children who underwent ventilator catheterization treatment in our hospital from January 2018 to August 2021 were selected for the study.The factors that may affect the occurrence of VAP in children with PICU were collected, and the children were divided into two groups according to the presence or absence of VAP. The above-mentioned factors were compared and multivariate logistic regression analysis was used to evaluate the comprehensive effect of each factor on the occurrence of VAP in children with PICU.ResultsAmong 196 children with PICU included in this study, 23 cases (11.73%) had VAP. A total of 31 pathogenic bacteria were isolated from 23 VAP patients, among which Gram-negative bacteria accounted for 58.06%, Gram-positive bacteria accounted for 32.26%, and fungi accounted for 9.68%.Based on univariate analysis, the results of uplink multivariate logistic regression analysis showed that: the duration of mechanical ventilation>3 d（OR=1.694，95%CI=1.204-2.382）, the number of intubation>1 times（OR=1.404，95%CI=1.010-1.951）, the use of glucocorticoids（OR=1.490，95%CI=1.039-2.138）, the use of proton pump inhibitors（OR=1.452，95%CI=1.112-1.896）, increased blood pH（OR=1.445，95%CI=1.066-1.958）, blood sugar elevated increased（OR=1.533，95%CI=1.116-2.105），and 25-hydroxyvitamin decrease D （OR=1.530，95%CI=1.073-2.181），and plasma albumin decreased（OR=1.441，95%CI=1.036-2.002）were risk factors for VAP in children with PICU (P<0.05). According to the results of multivariate analysis, the predicted value of the ROC curve showed that the Logistic model obtained in this study had an AUC of 0.840 for the prediction of VAP in children in PICU, with a 95%CI of 0.784-0.896.ConclusionVAP in PICU children is mainly caused by Gram-negative bacteria. The occurrence of VAP is related to the children’s plasma albumin level, 25-hydroxyvitamin D level, mechanical ventilation time and other factors, and clinical intervention can be carried out according to the above factors.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2022-09-06