强化康复单元医院获得性肺炎的影响因素分析

关键词：强化康复单元  重症患者  医院获得性肺炎  影响因素

Keywords:intensive rehabilitation care unit  critical patient  hospital-acquired pneumonia  influence of variables

摘要：

      摘要 目的：分析强化康复单元重症患者发生医院获得性肺炎的影响因素，指导肺炎防控措施的选择。 方法：回顾性分析2015年10月—2016年10月在强化康复单元住院治疗的患者108例，根据前4周内是否发生医院获得性肺炎，分为肺炎组和非肺炎组。所有患者收集其一般情况、基础疾病、实验室检查及辅助检查结果、医疗干预措施等相关临床资料，并记录干预措施的累计持续时间。 结果：共有59例患者发生医院获得性肺炎。单因素分析显示，肺炎组与非肺炎组之间血清白蛋白水平（t=-5.006，P=0.000）、意识水平（χ2=6.584，P=0.010）、使用声门下吸引功能的气管套管（χ2=6.438，P=0.011）、鼻饲管（P=0.045）、膨肺+振动排痰（χ2=7.521，P=0.006）的差异有显著性意义。二分类非条件Logistic回归分析显示，意识水平高（OR=0.222, 95% CI 0.065—0.757, P=0.016）、膨肺+振动排痰（OR=0.263, 95% CI 0.100—0.689, P=0.007）和血清白蛋白水平高（OR=0.776, 95% CI 0.684—0.879, P=0.000）是强化康复单元医院获得性肺炎的保护因素。 结论：意识水平高、膨肺+振动排痰和血清白蛋白水平高是强化康复单元医院获得性肺炎的保护因素，而使用声门下吸引功能的气管套管、鼻饲管亦对其的发生有一定影响，可在临床上采取有针对性的干预措施，降低医院获得性肺炎的发生率。

Abstract:

      Abstract Objective: To investigate the affecting factors of hospital-acquired pneumonia of critical patient in the intensive rehabilitation care unit, so as to guide the selection of pneumonia prevention and control measures. Method: A total of 108 inpatients in intensive rehabilitation care unit were selected from October 2015 to October 2016. According to whether hospital-acquired pneumonia happened in the first 4 weeks, all patients were divided into the pneumonia group and the non-pneumonia group. The clinical characteristics of all patients, including general conditions, basic diseases, laboratory tests results, auxiliary examination results, and medical intervention measures were recorded. And at the same time, the cumulative duration of intervention was recorded. Result: Among the 108 hospitalized patients, 59 cases had hospital-acquired pneumonia. Univariate analysis showed that the levels of serum albumin(t=-5.006, P=0.000), the levels of consciousness (χ2=6.584, P=0.010), tracheal cannula with subglottic attracting (χ2=6.438, P=0.011), nasal feeding tube (P=0.045), pulmonary inflation& discharging sputum with vibration (χ2=7.521, P=0.006) between the pneumonia group and the non-pneumonia group was statistically significant. Binary logistic regression analysis showed that high levels of consciousness (OR=0.222, 95% CI 0.065—0.757, P=0.016), pulmonary inflation& discharging sputum with vibration (OR=0.263, 95% CI 0.100—0.689, P=0.007), high levels of serum albumin(OR=0.776, 95% CI 0.684—0.879, P=0.000) were the protective factors for hospital-acquired pneumonia in intensive rehabilitation care unit. Conclusion: High levels of consciousness, pulmonary inflation& discharging sputum with vibration, high levels of serum albumin were the protective factors for hospital-acquired pneumonia in intensive rehabilitation care unit. Tracheal cannula with subglottic attracting, nasal feeding tube also affected the incidence of hospital-acquired pneumonia in intensive rehabilitation care unit. Targeted interventions can be taken in clinical work to reduce the incidence of hospital-acquired pneumonia.