| 冯园,张靖,王品.极低出生体质量早产儿呼吸机相关性肺炎现状调查及风险预测[J].安徽医药,2025,29(2):373-378. |
| 极低出生体质量早产儿呼吸机相关性肺炎现状调查及风险预测 |
| Status quo investigation and risk prediction of ventilator-associated pneumonia in premature infants with extremely low birth weight |
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| DOI：10.3969/j.issn.1009-6469.2025.02.033 |
| 中文关键词: 婴儿，极低出生体质量 早产儿 呼吸机相关性肺炎 病原菌 列线图 |
| 英文关键词: Infant,very low birth weigh Premature infants Ventilator-associated pneumonia Pathogens Nomogram |
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| 中文摘要: |
| 目的调查极低出生体质量早产儿并发呼吸机相关性肺炎(VAP)的现状，并构建其风险预测模型。方法回顾性收集 2019年 1月至 2022年 12月南阳市中心医院接受呼吸机辅助机械通气( MV)的 224例极低出生体质量早产儿的临床资料，统计 VAP发生率。采用 logistic回归模型分析极低出生体质量早产儿并发 VAP的危险因素，并据此构建风险预测列线图模型，采用一致性指数、校准曲线以及受试者操作特征曲线( ROC曲线)来评价模型的预测效能。结果 224例极低出生体质量早产儿的 VAP发生率为 24.55%。VAP病儿的气管分泌物共分离出 60株菌株，包括革兰阴性菌 42株( 70.00%)，革兰阳性菌 13株(21.67%)；真菌 5株( 8.33%)。 logistic回归分析显示，贫血、平卧、插管次数 ≥2次、每日气管内吸引次数增多、 MV时间延长、母亲合并妊娠期高血压均是极低出生体质量早产儿并发 VAP的独立危险因素( P<0.05)而静脉注射丙种球蛋白是保护因素( P< 0.05)。基于以上因素构建的极低出生体质量早产儿并发 VAP的风险预测列线图模型一，致性指数为 0.81，校准曲线与理想曲线吻合度良好， ROC曲线下面积为 0.82，95%CI:(0.76，0.88)列线图的决策曲线在 8%~82%的范围内预测极低出生体质量早产儿并发 VAP的净获益值较高。结论极低出生体质量早产，儿 VAP发生率较高，贫血、平卧、插管次数、每日气管内吸引次数、 MV时间、母亲合并妊娠期高血压均是其并发 VAP的独立影响因素，静脉注射丙种球蛋白为保护因素，据此建立的列线图模型对其并发 VAP的风险的预测效能良好。 |
| 英文摘要: |
| Objective To investigate the status quo of ventilator-associated pneumonia (VAP) in premature infants with extremely low birth weight, and to establish a risk prediction model. Methods The clinical data of 224 premature infants with extremely lowbirth weight who received mechanical ventilation (MV) in Nanyang Central Hospital from January 2019 to December 2022 were retro-spectively collected, and the incidence of VAP was calculated. Risk factors for VAP in premature infants with extremely low birthweight were analyzed by a logistic regression model, and a nomograph model for prediction of risks was established based on the aboverisk factors. The consistency index, calibration curve, and the receiver operating characteristic (ROC) curve were used to evaluate theprediction efficiency of the model.Results The incidence rate of VAP in 224 premature infants with extremely low body weight was24.55%. A total of 60 strains were isolated from the bacterial culture of trachea secretion of children with VAP, including 42 strains(70.00%) of Gram negative bacteria, 13 strains (21.67%) of Gram positive bacteria, and 5 strains (8.33%) of fungi. Logistic regressionanalysis results showed that anemia, lying flat, intubation times ≥ 2, increased daily tracheal suction frequency, prolonged MV time,and maternal hypertension during pregnancy were independent risk factors for VAP in premature infants with extremely low birthweight (P<0.05), while the intravenous gamma globulin was a protective factor (P<0.05). The consistency index of the nomograph modelfor predicting VAP risk in premature infants with extremely low birth weight established based on the above factors was 0.81, the cali-bration curve fit well with the ideal curve, and the area under the ROC curve was 0.82,95%CI:(0.76,0.88). The decision curve of the no-mograph predicting VAP in extremely low birth weight premature infants had a high net benefit value in the range of 8% to 82%.Con. clusions Premature infants with extremely low birth weight have a high incidence rate of VAP, and anemia, lying flat, times of intuba-tion, frequency of daily endotracheal suction, MV time, and maternal hypertension during pregnancy are all independent influencingfactors for VAP in them, and intravenous gamma globulin is a protective factor. The nomograph model established based on above fac-tors has a good predictive effect on the VAP risk in them. |
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