Clinical Characteristics,Influencing Factors And Prognostic Analysis Of Aspiration Pneumonia In ICU

Objectives To analyze the clinical characteristics,influencing factors and prognosis of aspiration pneumonia in ICU.Methods 1.From April 2017 to October 2018,187 patients with pneumonia admitted to our hospital with ICU were selected.According to the occurrence of aspiration pneumonia,there were two groups of aspiration pneumonia group and non-aspiration pneumonia group.The clinical characteristics and influencing factors of aspiration pneumonia were analyzed by comparing and collecting the clinical data of the two groups.2.All cases were examined by fiberoptic bronchoscopy,and about 10 ml of alpha amylase activity,bacterial and fungal culture were taken from bronchoalveolar lavage fluid(BALF).Analysis of the sensitivity and specificity of BALF?-amylase in the diagnosis of aspiration pneumonia markers,and the aspiration pneumonia group was further divided into chemical aspiration pneumonia group and infectious aspiration pneumonia group according to whether the pathogenic bacteria were positive,and the prognosis of chemical aspiration pneumonia and infective aspiration pneumonia was compared.Results 1.There was no statistically significant difference in sex,onset symptoms,peripheral blood leukocyte count,blood inflammation level(CRP,PCT,IL-6)and other indexes in the aspiration pneumonia group and the non-aspiration pneumonia group(P>0.05),but there were differences in age,ICU time,length of stay,mortality and the results were statistically significant(P<0.05).When the factors influencing aspiration pneumonia were analyzed by single factor,there were statistically significant indexes such as age,nasal feeding,repeated vomiting,consciousness disorder,history of upper gastrointestinal surgery,chronic basic history and BALF?-amylase level.Multi-Factor Logistic regression analysis of meaningful single factors showed that the factors influencing the occurrence of aspiration pneumonia mainly included age,repeated vomiting,consciousness disorder,history of upper gastrointestinal surgery and BALF?-amylase level.2.BALF?-amylase level can be used to diagnose aspiration pneumonia,the area under the curve is 0.786,sensitivity 0.625,specificity 0.958,95% confidence interval is 0.649-0.922,P=0.001,the diagnostic threshold is 126.5u/l.3.187 cases were included,a total of 98 strains were cultured,80 strains of aspiration pneumonia(81.6%),and the main strains(top three)were Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa.18 strains in non-aspiration pneumonia group(18.4%),The first three strains were Acinetobacter baumannii,Pseudomonas aeruginosa and Escherichia coli.The aspiration pneumonia group was more common than mixed infection(16.06%vs4%,P<0.05).The anti-infection aspect is mainly combined with anti-infection program,and the antibiotic adjustment is more frequent.4.Infectious aspiration pneumonia is statistically significant in terms of invasive mechanical ventilation time,length of stay,time spent on ICU and mortality compared to chemical aspiration pneumonia(P<0.05).Conclusions 1.Aspiration pneumonia has the characteristics of high severity,long hospitalization time and high mortality rate,especially infectious aspiration pneumonia.2.Age,history of upper gastrointestinal surgery,repeated vomiting and consciousness disorder are the factors influencing the occurrence of aspiration pneumonia.3.BALF?-amylase levels are used to diagnose aspiration pneumonia with a threshold of 126.5u/l.