Analysis Of The ICU Mechanical Ventilation In Patients With Ventilator Associated Pneumonia Risk Factors And Prognosis

ObjectivesHospitalization for intensive medicine (ICU) of ventilator associated pneumonia (hap) in patients with mechanical ventilation of risk factors and prognosis of clinical research and to study the methods of preventing and reducing the ventilator associated pneumonia (VAP), so as to provide theoretical basis for clinical treatment and prevention.MethodsThis paper use the investigation method of retrospective case-control and according to exclusion criteria in this study and in this paper select the intensive medicine (ICU) hospitalization of ventilator associated pneumonia (VAP) in patients with mechanical ventilation and mechanical ventilation ventilator associated pneumonia (VAP) in patients with ventilator the first hospital affiliated to Zhejiang university school of medicine from May,2013 to May,2015 to study the associated pneumonia risk factors and the prognosis of clinical studies. This paper use the medical records, sputum culture bacteriology test data, the main pathogenic bacteria medicine sensitive experiment results check data, laboratory examination and combination of ICU monitoring data to collect the related materials. And this paper adopts SPSS 19.0 statistical software for data analysis. For continuous variables, the results to mean+/-standard deviation (mean +/-SD); and the classification variables to the number of cases (%) (N,%).If the measuring data in these two groups conform to a normal distribution and its use the Z test to make comparison. If the measuring data do not accord with normal distribution and it uses the repeated measurement data by using the analysis of variance. The comparison of count data by chi-square test and ventilator associated pneumonia in patients with ICU mechanical ventilation single factor analysis of risk factors using chi-square test and the multiple factors analysis to the single factor analysis of meaningful variables into the multi-factor logistic regression analysis by using stepwise regression method and the patterns standard is 0.05, excluding the standard is 0.10.Results1. This study found that the success rate of patients with ventilator associated pneumonia (VAP) withdraw machine was 45.45% and the withdraw machine failure parallel trachea cut the incidence of long-term mechanical ventilation was 13.64% and the mortality rate is 40.91%. The success rate of no ventilator associated pneumonia (VAP) in patients with ventilator was 85.40% and the rate of withdraw machine failure incidence of parallel parallel airway long-term mechanical ventilation was 2.92% and the mortality rate was 11.68%. After statistics inspection found that both the success rate of ventilator and withdraw machine failure parallel airway long-term mechanical ventilation incidence, mortality, compare differences were statistically significant (chi-square= 35.581,35.581,8.535, P<0.05).2. By the single factor analysis of this study found that patients with ventilator associated pneumonia (VAP) and ventilator associated pneumonia (VAP) in age, serum albumin, blood sugar levels, gastric juice PH value position, ventilation, mechanical ventilation time and days of continuous use of antibiotics, APACHE II score, the use of H2 receptor antagonist of feeding time, types of antibiotics and nutrition time, suffering from COPD, tracheotomy, again intubation, oropharyngeal bacteria to colonize and unconscious statistically difference (P<0.05). This paper not found the patients with ventilator associated pneumonia (VAP) and ventilator associated pneumonia (VAP) in patients in the gender, the use of diuretics time, use of corticosteroids, stomach gram-negative bacillus engraftment statistically difference (P> 0.05).3. After the adjustment of this study for age of multi-factor analysis found that serum albumin levels< 30 g/L and blood sugar levels or greater tendency for 7.8/L and gastric juice PH> position the hypothesis 4,ventilation,mechanical ventilation time> 5d, APACHE II score 15 points, kinds of antibiotics>two days of continuous use, antibiotics> 3 d> 15 years, suffering from COPD time, tracheotomy, again intubation and the incidence of ventilator associated pneumonia (VAP) have significant correlation, ventilator associated pneumonia (VAP) is a risk factor for disease.4. Through this study of ventilator associated pneumonia (VAP) in patients with sputum culture and found that the main pathogenic bacteria are gram-negative bacteria, after the infection of pathogenic bacteria bowman’s acinetobacter, klebsiella pneumoniae, white coli, pseudomonas aeruginosa to commonly used antimicrobial susceptibility analysis, found the to penicillin, ampicillin, cephalosporins and ciprofloxacin, sand magnitude higher resistance; To meropenem,Imipenem, enzyme compound inhibitors such as antimicrobial agents and amikacin resistance is low, higher sensitivity. By drug sensitive experiment, all the patients with ventilator associated pneumonia (VAP) were carried out reasonable norms of antibiotic treatment. Then the ventilator associated pneumonia (VAP) for patients with ventilator associated pneumonia (VAP) death in patients with mechanical ventilation time and ICU were analyzed, and the time found that patients with ventilator associated pneumonia (VAP) death time of mechanical ventilation, ICU time, were significantly higher than that of patients with ventilator associated pneumonia (VAP) survival and statistically difference (P< 0.05). In patients with ventilator associated pneumonia (VAP) for patients with ventilator associated pneumonia (VAP) death APACHE Ⅱ score, dynamic changes CPIS score repeated measurement data analysis of variance, found alive and death in patients with two groups of patients with APACHE Ⅱ score difference was statistically significant (group F= 15.197, p=15.197). Death in patients with APACHE Ⅱ score increased with prolonged mechanical ventilation (F=50.229, p=50.229). Survival and death in patients CPIS score similar between the two groups have statistical significance (group F=10.215, p=10.215). Death patients CPIS score also increases with prolonged mechanical ventilation (F= 43.157, p=43.157).Conclusions1. The level of serum albumin IS< 30 g/L, the level of blood sugar is greater tendency for 7.8/L, the PH of gastric juice is> 4 and the postures hypothesis, ventilation, mechanical ventilation time is> 5 d, APACHE Ⅱ score>15 points, kinds of antibiotics> 2 and the continuous use of antibiotics> 3, suffering from COPD time is more than 15 years. The tracheotomy, reintubation and the incidence of ventilator associated pneumonia (VAP) have significant correlation and it is a risk factor for ventilator associated pneumonia (VAP).2. meropenem,Imipenem, enzyme compound inhibitors such as antimicrobial agents and amikacin can be a ventilator associated pneumonia (VAP) in the treatment of drug use.3. Patients with ventilator associated pneumonia (VAP) are more likely be difficult away from the machine and mortality is higher, the time of the ventilation time for patients and ICU needs a long time. The score of APACHE II and CPIS are higher and doctors need to strengthen the monitoring, vigilance, earlier treatment, prevent its onset, reduce mortality.4. The pathogenic factors of ventilator associated pneumonia (VAP) is more. But many of them are pathogenic factors and they are reliable and can prevent effectively. Ventilation position, mechanical ventilation time, kinds of antibiotics> 2, reintubation, combined with pulmonary disease is prevention of ventilator-associated pneumonia (VAP) of the key.