Analysis Of Risk Factors And Countermeasures For Ventilator-associated Pneumonia In Elderly Patients In Neurosurgical Intensive Care Unit

Objective:With the popularization of the ventilator in the clinic,the incidence of ventilator-associated pneumonia(VAP)is more and more,and the harm is becoming more and more serious.This study conducted a retrospective investigation and study of the elderly patients with mechanical ventilation in neurosurgical intensive care unit(NICU).The results are summarized and analyzed.The epidemiology,pathological mechanism and prevention strategy of VAP were discussed.The purpose is to provide a theoretical basis for the treatment and prevention of clinical VAP..Methods:A retrospective case-control study was conducted to retrospectively analyze the clinical data of elderly patients admitted to the NICU of Hebei General Hospital from January 2015 to December 2016.After screening,110selected subjects were divided into two groups according to the VAP or not.The clinical information needed to collect this study,including general information,laboratory data and intensive care information,was recorded by referring to medical records and other methods.Data were analyzed statistically using SPSS 19.0 software.The measurement data is represented by mean±standard deviation(??±S).The counting data is expressed in terms of frequency(N)and percentage(%).In this study,the counting data was used.Single factor analysis adopted?~2 test(P?0.05 means the difference was statistically significant).Multivariate analysis adopted binary logistic regression analysis.Stepwise selection method is adopted(Forward:LR)(0.10for inclusion and rejection criteria).Results:1.Incidence rate:The incidence of 52 cases of VAP in 110 elderly patients with mechanical ventilation in NICU was 47.27%.2.Pathogenic bacteria test:Totally 81 pathogenic bacteria were co-cultivated in respiratory secretions of 52 patients with VAP,including 52Gram-negative bacteria(64.20%),27 Gram-positive bacteria(33.33%)and2 fungi(2.47%).Gram-negative bacteria infection rate(64.20%)was significantly higher than Gram-positive bacteria(33.33%)and fungi(2.47%).The difference was statistically significant(P<0.05).The first three Gram-negative bacteria were Acinetobacter Bauman,Klebsiella pneumoniae and Pseudomonas aeruginosa.The first two Gram-positive bacteria were Staphylococcus aureus and Staphylococcus epidermidis.3.Drug sensitivity test:Gram-negative bacteria are more sensitive to complex enzyme inhibitors and amikacin and are highly sensitive to imipenem and meropenem.Gram-positive bacteria are highly sensitive to vancomycin and teicoplanin and are 100%resistant to penicillin and more resistant to most other antibiotics.In particular,methicillin-resistant Staphylococcus aureus(MRSA)is highly resistant to the vast majority of antibiotics.All patients with VAP were treated with a standardized anti infection treatment by drug sensitivity test.4.Single factor analysis of risk factors:history of smoking,coma,APACHE II score>15 points,serum albumin<30 g/L,blood glucose level?7.8mmol/L,tracheotomy,time of mechanical ventilation?5 days,oropharyngeal bacterial colonization,time of use of antacids>3 days,antibiotic combined species>2 and time for continuous use of antibiotics>3 days are risk factors for VAP in elderly patients with mechanical ventilation in NICU(P<0.05).5.Multivariate analysis of risk factors:There is a significant correlation between APACHE II score>15 points,serum albumin<30 g/L,tracheotomy,time of mechanical ventilation?5 days,antibiotic combined species>2 and the incidence of VAP in elderly patients with mechanical ventilation in NICU.These risk factors are independent risk factors for the occurrence of VAP(0.10for inclusion and rejection criteria).The odds ratio(OR)values were2.943,3.252,4.503,4.106,3.662.Conclusion:1.The elderly patients with mechanical ventilation in NICU have a higher incidence of VAP.The main pathogens is gram-negative bacteria.Gram-negative bacteria detected by drug sensitivity are more sensitive to compound inhibitors and amikacin,and are highly sensitive to imipenem and meropenem.Gram-positive bacteria are highly susceptible to vancomycin and teicoplanin.These drugs can be used as the treatment of VAP.2.For elderly patients with mechanical ventilation in NICU,history of smoking,coma,APACHE II score>15 points,serum albumin<30 g/L,blood glucose level?7.8 mmol/L,tracheotomy,time of mechanical ventilation?5days,oropharyngeal bacterial colonization,time of use of antacids>3 days,antibiotic combined species>2 and time for the continuous use of antibiotics>3 days are risk factors for VAP.APACHE II score>15 points,serum albumin<30 g/L,tracheotomy,time of mechanical ventilation?5 days,antibiotic combined species>2 are its independent risk factors.3.Although the incidence of VAP is higher,and there are more risk factors.The prevention and control of controllable risk factors and prevention based on evidence-based medical evidence can effectively reduce the incidence of VAP and improve the prognosis.