呼吸机相关事件的目标性监测

Targeted monitoring on ventilatorassociated events

摘要:

目的在我国重症监护病房（ICU）首次监测呼吸机相关事件（VAE），了解VAE在我国的适用性、发生率和临床意义。方法对2014年1月—2015年9月某院中心ICU年龄≥18岁、机械通气（MV）>2 d的患者进行VAE目标性监测，统计VAE发生率，并根据是否发生VAE分组，对预后指标进行统计分析。结果共监患者1 004例，使用呼吸机患者住院日为13 795 d，发生VAE 307例次，例次发生率为30.58%，日发生率为22.25‰。单因素分析的结果显示：VAE患者较无VAE的MV患者：住ICU时间和MV时间延长，出ICU时病死率更高（均P＜0.05）。多因素回归分析结果显示：VAE分别是住ICU时间、MV时间和出ICU时死亡的独立危险因素（均P＜0.05）。结论VAE的判断指标基于MV参数，更客观、准确。VAE在ICU患者中有较高的发生率，很可能带来更差的临床预后，在我国大型医院综合ICU患者中具有较高的监测价值。

Abstract:

ObjectiveTo monitor ventilatorassociated event (VAE) for the first time in an intensive care unit (ICU) in China, understand the applicability, incidence，and clinical significance of VAE in China.MethodsTargeted monitoring on VAE was performed among patients ≥18 years and with mechanical ventilation (MV)>2 days in the ICU of a hospital between January 2014 and September 2015, incidence of VAE was calculated, and patients were grouped according to whether or not they had VAE, prognostic factors were analyzed statistically.ResultsA total of 1 004 patients were monitored, the total hospital stay was 13 795 days in patients who used ventilator, 307 (30.58%) cases of VAE occurred, incidence of VAE per 1 000 ventilatordays was 22.25. Univariate analysis showed that patients with VAE had longer length of ICU stay and MV, and higher mortality rate than patients without VAE when they moved out of ICU (all P<0.05). Multivariate logistic regression analysis showed that VAE was independent risk factor for length of ICU stay, duration of MV, as well as mortality when patients moved out of ICU(all P<0.05).ConclusionJudgment of VAE is based on MV parameters, it is more objective and accurate. There is a high incidence of VAE among ICU patients, it may lead to poor clinical outcomes, and has good values for the targeted monitoring on ICU patients in large comprehensive hospitals of China.