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新生儿呼吸机相关性肺炎的发病率、病原菌特点及影响因素分析

Analysis in incidence, pathogen characteristics and influencing factors of neonatal ventilator-associated pneumonia

    摘要
  • 摘要:
      目的  探讨新生儿呼吸机相关性肺炎（VAP）的发病率、病原菌特点和影响因素。
      方法  选取2018年1月—2021年10月江苏省盐城市妇幼保健院收治的192例行机械通气的新生儿作为研究对象，收集其临床资料并统计新生儿VAP发生情况。对VAP患儿进行痰液病原菌检查，分析其病原菌分布情况，并对新生儿VAP发生的影响因素进行单因素和多因素Logistic回归分析。
      结果  192例行机械通气的新生儿中，24例发生VAP，VAP发病率为12.50%。24例VAP患儿痰液标本中共分离出病原菌株29株，其中革兰阴性菌、革兰阳性菌分别占比72.41%、27.59%；革兰阴性菌中，肺炎克雷伯菌占比最高（占27.59%）；革兰阳性菌中，金黄色葡萄球菌占比最高（占13.79%）。VAP患儿性别、分娩方式与无VAP患儿比较，差异无统计学意义（P>0.05）；VAP患儿胎龄、出生体质量、出生后1 min Apgar评分、白蛋白水平、原发性疾病、床头抬高情况、脱机失败再插管情况、吸痰方式、机械通气时间与无VAP患儿比较，差异有统计学意义（P < 0.05）。多因素Logistic回归分析显示，胎龄、出生体质量、出生后1 min Apgar评分、白蛋白水平、床头抬高、脱机失败再插管、吸痰方式和机械通气时间均为新生儿VAP发生的影响因素（P < 0.05）。
      结论  2018年1月—2021年10月江苏省盐城市妇幼保健院新生儿VAP发病率较高，其病原菌以革兰阴性菌为主，新生儿VAP的发生与多种因素有关，临床宜根据相关影响因素采取针对性防范措施。

     

    Abstract:
      Objective  To analyze the incidence, pathogen characteristics and influencing factors of neonatal ventilator-associated pneumonia (VAP).
      Methods  A total of 192 neonates from January 2018 to October 2021 in Yancheng Maternal and Child Health Hospital of Jiangsu Province were selected as study subjects. The clinical data were collected and the incidence of VAP was analyzed. Sputum pathogen was examined in children with VAP, and the distribution of pathogens was analyzed. Univariate and multivariate Logistic regression analysis were performed on the influencing factors of neonatal VAP.
      Results  VAP occurred in 24 of 192 neonates who underwent mechanical ventilation, and the incidence of VAP was 12.50%. A total of 29 strains were isolated from 24 VAP neonates, of which Gram-negative and Gram-positive strains accounted for 72.41% and 27.59%, respectively. In Gram-negative bacteria, Klebsiella pneumoniae accounted for the highest proportion (27.59%). In Gram-positive bacteria, Staphylococcus aureus accounted for the highest proportion (13.79%). There were no significant differences in gender and delivery mode between VAP and non-VAP children (P>0.05). There were significant differences in gestational age, birth weight, Apgar score at 1min after birth, albumin level, primary diseases, bedside elevation, re-intubation after weaning failure, sputum aspiration mode and mechanical ventilation time between VAP and non-VAP children (P < 0.05). Multivariate Logistic regression analysis showed that gestational age, birth weight, Apgar score at 1 minute after birth, albumin level, bedside elevation, intubation after weaning failure, sputum aspiration method and mechanical ventilation time were the influential factors for the occurrence of neonatal VAP (P < 0.05).
      Conclusion  The incidence of neonatal VAP is high in Yancheng Maternal and Child Health Hospital of Jiangsu Province from January 2018 to October 2021, and the pathogenic bacteria are mainly Gram-negative bacteria. The occurrence of neonatal VAP is related to a variety of factors, and the clinical measures should be taken according to the relevant influencing factors.

     

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