Abstract:

Objective　To analyze the risk factors of ventilator-associated pneumonia (VAP) in patients at respiratory intensive care unit (RICU), and to construct a risk prediction model and draw a graph. Methods　A total of 796 patients who received mechanical ventilation for more than 48 h and had complete clinical examination data in RICU, Inner Mongolia People's Hospital from January 1, 2020 to December 31, 2022 were selected as the study objects. The patients were divided into a VAP group (285 cases) and a non-VAP group (511 cases) according to whether the patients had infectious pneumonia after receiving mechanical ventilation for more than 48 h or removing the machines and pulling out the tubes within 48 h. The risk factors of VAP were analyzed by the univariate and multivariate logistic analyses. The R software was used to draw the nomograms. Results　The incidence of VAP in the patients was 35.80% (285/796). Cerebral infarction, antibiotics combination, central venous catheter, urinary catheter, ventilator using days, and antibiotics using days were the independent risk factors of VAP (OR=1.752, 2.406, 4.596 4.503, 1.209, and 1.093; all P<0.05). The area under the model's receiver operating characteristic curve was 0.925 (95%CI 0.907-0.944). Conclusions　The independent risk factors of VAP in RICU should be paid attention to and evaluated in time in clinical work. The predictive model for the risk factors of VAP is effective, and can provide some references in the prediction of the risk of patients with VAP.

Key words:

Intensive care unit, Ventilator-associated pneumonia, Risk factors, Predictive model

摘要：

目的　分析呼吸重症监护病房（RICU）患者发生呼吸机相关性肺炎（VAP）的危险因素，构建预测模型及绘制列线图。方法　选取内蒙古自治区人民医院2020年1月1日至2022年12月31日RICU接受呼吸机机械通气治疗48 h以上、临床检查资料完整的796例患者为研究对象，其中男性590例、女性206例，年龄24～96（71.52±11.50）岁。根据患者机械通气48 h以上或撤机拔管48 h内是否出现肺部感染性肺炎分为VAP组（285例）和非VAP组（511例）。使用单因素、多因素logistic分析的方法对患者发生VAP的危险因素进行分析；使用R软件绘制列线图。结果　RICU患者VAP的发生率为35.80%（285/796）；脑梗死、是否联用抗菌药物、中心静脉导管、尿路导管、呼吸机使用天数、抗菌药物使用天数是VAP发生的独立危险因素（OR=1.752、2.406、4.596、4.503、1.209、1.093，均P<0.05）。模型受试者操作特征曲线（ROC）曲线下面积（AUC）为0.925（95%CI 0.907～0.944）。结论　针对RICU患者发生VAP的独立危险因素，临床工作中应予以关注并及时评估。VAP风险预测模型有一定预测效果，可为预测患者VAP发生风险提供依据。

关键词:

重症监护病房, 呼吸机相关性肺炎, 危险因素, 预测模型