营养状况障碍与重症监护病房呼吸机相关性肺炎（VAP）患者的选定危险因素：一项回顾性研究。
Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward-A Retrospective Study.
机构信息
Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland.
Laboratory of Theory and Fundamentals of Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland.
出版信息
Int J Environ Res Public Health. 2022 Jan 5;19(1):602. doi: 10.3390/ijerph19010602.
INTRODUCTION
The development of pneumonia in patients treated in intensive care wards is influenced by numerous factors resulting from the primary health condition and co-morbidities. The aim of this study is the determination of the correlation between nutritional status disorders and selected risk factors (type of injury, epidemiological factors, mortality risk, inflammation parameters, age, and gender) and the time of pneumonia occurrence in patients mechanically ventilated in intensive care wards.
MATERIAL AND METHOD
The study included 121 patients with injuries treated in the intensive care ward who had been diagnosed with pneumonia related to mechanical ventilation. The data were collected using the method of retrospective analysis of patients' medical records available in the electronic system.
RESULTS
Ventilator-associated pneumonia (VAP) occurred more frequently in patients over 61 years of age (40.4%), men (67.8%), after multiple-organ injury (45.5%), and those with a lower albumin level (86%), higher CRP values (83.5%), and leukocytes (68.6%). The risk of under-nutrition assessed with the NRS-2002 system was confirmed in the whole study group. The statistical analysis demonstrated a correlation between the leukocytes level ( = 0.012) and epidemiological factors ( = 0.035) and the VAP contraction time. Patients infected with Staphylococcus aureus had 4% of odds for the development of late VAP in comparison to Acinetobacter baumannii ( < 0.001), whereas patients infected by any other bacteria or fungi had about four times lower odds of the development of late VAP in comparison to Acinetobacter baumannii ( = 0.02). Patients with results in APACHE from 20 to 24 and from 25 to 29 had 13% and 21%, respectively, odds of the development of late VAP in comparison to patients with APACHE II scores ranging from 10 to 19 (respectively, = 0.006; = 0.028).
CONCLUSIONS
The development of VAP is impacted by many factors, the monitoring of which has to be included in prophylactics and treatment.
简介
重症监护病房患者肺炎的发生受到许多因素的影响，这些因素源自原发健康状况和合并症。本研究的目的是确定营养状况障碍与选定的风险因素（损伤类型、流行病学因素、死亡风险、炎症参数、年龄和性别）之间的相关性，以及在重症监护病房接受机械通气的患者中肺炎发生的时间。
材料与方法
该研究纳入了 121 名在重症监护病房接受治疗的创伤患者，这些患者被诊断患有与机械通气相关的肺炎。数据是通过回顾性分析电子系统中患者病历的方法收集的。
结果
呼吸机相关性肺炎（VAP）在 61 岁以上患者（40.4%）、男性（67.8%）、多发器官损伤患者（45.5%）和白蛋白水平较低的患者（86%）、CRP 值较高的患者（83.5%）和白细胞计数较高的患者（68.6%）中更为常见。应用 NRS-2002 系统评估的营养不良风险在整个研究组中得到了确认。统计分析显示，白细胞计数（ = 0.012）和流行病学因素（ = 0.035）与 VAP 发病时间之间存在相关性。与鲍曼不动杆菌相比，金黄色葡萄球菌感染患者发生晚期 VAP 的几率为 4%（ < 0.001），而任何其他细菌或真菌感染患者发生晚期 VAP 的几率则降低了约四倍（ = 0.02）。APACHE 评分在 20 到 24 分和 25 到 29 分的患者与 APACHE II 评分在 10 到 19 分的患者相比，发生晚期 VAP 的几率分别为 13%和 21%（分别为 = 0.006； = 0.028）。
结论
VAP 的发生受到许多因素的影响，这些因素的监测必须纳入预防和治疗措施中。
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