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医学免费论文:新生儿呼吸机相关性肺炎危险因素分析
【摘要】 目的 通过分析新生儿重症监护病房呼吸机相关性肺炎的临床特点，探讨呼吸机相关性肺炎的危险因素。方法 对机械通气超过48 h的134例新生儿临床资料做回顾性分析，分析机械通气持续时间、胎龄、出生体质量、血浆蛋白水平、PaO2/FiO2、氧合指数、pH值与呼吸机相关性肺炎发生的相关性。结果 新生儿呼吸机相关性肺炎的发生率为40.30%，单因素分析机械通气持续时间、胎龄、出生体质量、血浆蛋白水平与呼吸机相关性肺炎的发生差异有显著性(P<0.05);而PaO2/FiO2、氧合指数、pH值差异无统计学意义(P>0.05);多因素Logistic回归分析机械通气持续时间与呼吸机相关性肺炎的发生呈正相关(OR=3.149，95% CI=1.513～5.663，P<0.001)，而血浆白蛋白水平呈负相关(OR=0.795，95% CI=0.695～0.938，P<0.05)。结论 机械通气持续时间、血浆白蛋白水平是新生儿呼吸机相关性肺炎发生的危险因素医.学全.在.线网站www.med126.com。
【关键词】 机械通气;肺炎;新生儿
An analysis of risk factors in neonatal ventilator-associated pneumonia
CHANG Ming，YANG Li，GU Shao-qing.Department of Pediatrics，The Affiliated Hospital of Jiangsu University，Zhenjiang 212001，China
[Abstract] Objective To analyse the clinical characteristics of ventilator-associated pneumonia in neonatal intensive care unit and to investigate the risk factors in neonatal ventilator-associated pneumonia.Methods An retrospective analysis of clinical data of 134 newborns with mechanical ventilation >48 hours was done.To investigate the correlation of the duration of mechanical ventilation，gestational ages，birth weights，the plasma protein levels，PaO2/FiO2，oxygenation index and pH values with neonatal ventilator-associated pneumonia.Results The incidence rate of neonatal ventilator-associated pneumonia was 40.30%.Univariate analysis showed that there were significantly difference for the duration of mechanical ventilation，gestational ages，birth weights，the plasma protein levels in neonatal ventilator-associated pneumonia and non-ventilator-associated pneumonia(P<0.05)，and there were no significantly difference for PaO2/FiO2，oxygenation index and pH values respectively(P>0.05).Multivariate stepwise logistic regression analysis showed that the duration of mechanical ventilation was positive correlation with neonatal ventilator-associated pneumonia(OR=3.149，95% CI=1.513～5.663，P<0.001)and the plasma albumin level was negative correlation with neonatal ventilator-associated pneumonia(OR=0.795，95% CI=0.695～0.938，P<0.05).Conclusion The duration of mechanical ventilation and the plasma albumin level were the risk factors in neonatal ventilator-associated pneumonia.
[Key words] mechanical ventilation;pneumonia;neonate
机械通气(mechanical ventilation，MV)是治疗呼吸衰竭的主要措施，随着呼吸机在NICU的普及，新生儿抢救成功率大为提高，但其并发症——呼吸机相关性肺炎(ventilator-associated pneumonia，VAP)也成为医院内主要的获得性感染，VAP的预后直接关系到呼吸衰竭抢救成功与否。现将2007年1月至2008年12月在NICU进行MV的新生儿临床资料进行回顾性分析，探讨VAP发生的危险因素，为针对性预防及治疗提供临床依据。
