低出生体质量儿呼吸机相关性肺炎的风险因素研究-东南大学学报医学版

低出生体质量儿呼吸机相关性肺炎的风险因素研究

单位：南方医科大学珠江医院三水医院/佛山市三水区人民医院儿科, 广东佛山 528100

分类号：R563

出版年·卷·期（页码）：2025·44·第四期（593-598）

摘要：

目的:分析低出生体质量儿呼吸机相关性肺炎(VAP)的风险因素。方法:选取2023年6月至2024年12月佛山市三水区人民医院儿科收治的132例低出生体质量儿为研究对象,收集其临床资料并统计其VAP发生率。据患儿是否发生VAP分为VAP组和无VAP组,对比两组临床资料及排痰方案等,经二元Logistic回归分析低出生体质量儿并发VAP的独立影响因素,建立预测模型并经受试者工作特征(ROC)曲线分析该模型的预测效能。结果:39例低出生体质量儿发生VAP,发生率为29.55%;机械通气时间及插管次数为发生VAP的独立危险性因素,出生后1 min Apgar评分高、电动牙刷叩背、预防性使用抗菌药物是VAP的保护因素(P＜0.05);低出生体质量儿发生VAP预测模型为P=1/[1+e^{-(-12.376-0.389×出生后1 min Apgar评分+0.288×}^{机械通气时间+0.467×插管次数-0.455×排痰方式-0.539×预防性使用抗菌药物)}],该模型Hosmer-Lemeshow检验有较好拟合优度(P=0.297),ROC曲线显示其预测低出生体质量儿发生VAP的曲线下面积为0.881(95%CI:0.827~0.935),敏感度、特异度分别为85.27%、82.93%。结论:低出生体质量儿的VAP发生风险较高,机械通气时间、插管次数、出生后1 min Apgar评分、排痰方式、预防性使用抗菌药物是其独立影响因素,据此建立的预测模型效能较好。

Objective: To analyze the risk factors of ventilator-associated pneumonia(VAP) in low birth weight infants. Methods: A total of 132 low birth weight infants admitted to the Department of Pediatrics of Sanshui District People's Hospital of Foshan City from June 2023 to December 2024 were studied. Their clinical data were collected, and the incidence of VAP was analyzed. The patients were divided into VAP group and non-VAP group. By comparing the clinical data and expectoration plan, the independent influencing factors of VAP in patients were analyzed by binary Logistic regression. The predictive model was established and the predictive efficiency of the model was analyzed by receiver operating characteristic(ROC) curve. Results: VAP occurred in 39 low birth weight infants(29.55%). Mechanical ventilation time and intubation times were independent risk factors, while high Apgar score 1 min after birth, back tapping with electric toothbrush and preventive use of antibiotics were protective factors for VAP(P<0.05); Prediction model for VAP in low birth weight infants: P=1/[1+e^{-(-12.376-0.389×Apgar score 1 min} ^{after birth+ 0.288×mechanical ventilation time+0.467×intubation times-0.455×back tapping with electric toothbrush-0.539×preventive use of antibiotics})]. The Hosmer-Lemeshow test of this model had a good goodness of fit(P=0.297). ROC curve showed that the area under the curve for predicting VAP in low birth weight infants was 0.881(95%CI:0.827-0.935), and the sensitivity and specificity were 85.27% and 82.93%, respectively. Conclusion: The risk of VAP in low birth weight infants is higher, and the independent factors are mechanical ventilation time, intubation times, Apgar score 1 min after birth, back tapping with electric toothbrush and preventive use of antibiotics.

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