| 匡荣岩,魏秀娥,李增杰,等.ICU呼吸机相关性肺炎危险因素及其 PDCA循环管理干预效果分析[J].安徽医药,2026,30(3):547-552. |
| ICU呼吸机相关性肺炎危险因素及其 PDCA循环管理干预效果分析 |
| Risk factors for ventilator-associated pneumonia in ICU and the effects of PDCA cycle management interventions |
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| DOI：10.3969/j.issn.1009-6469.2026.03.023 |
| 中文关键词: 肺炎，呼吸机相关性 重症监护室 危险因素 PDCA循环(戴明环) 干预 |
| 英文关键词: Pneumonia, ventilator-associated Intensive care unit Risk factors PDCA cycle (Deming circle) Intervene |
| 基金项目:山东省医院协会 2019年度医院管理研究课题( SDPHA201909002) |
| 作者 | 单位 | E-mail | | 匡荣岩 | 青岛市胶州中心医院,神经外科,山东青岛 266300 | | | 魏秀娥 | 青岛市胶州中心医院,医院办公室,山东青岛 266300 | | | 李增杰 | 青岛市胶州中心医院,泌尿外科,山东青岛 266300 | | | 魏瑞雪 | 青岛市胶州中心医院,健康管理科,山东青岛 266300 | 18661609780@163.com | | 王清妍 | 青岛市胶州中心医院,院感科,山东青岛 266300 | |
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| 中文摘要: |
| 目的探讨重症监护室( ICU)呼吸机相关性肺炎(VAP)危险因素及其计划 -执行 -检查 -处理(PDCA)循环管理干预效果。方法选取青岛市胶州中心医院在 2021年 2月至 2024年 1月 ICU发生 VAP的病人 62例作为 VAP组，另选取 ICU同期接受机械通气未发生 VAP的病人 124例作为未 VAP组，收集两组临床资料，采用 logistic回归分析探究危险因素，经回归方程拟合的概率值绘制受试者操作特征曲线( ROC曲线)。此外将该院 ICU在 2023年 8月至 2024年 1月接受机械通气的病人 95例归为对照组，实施常规防控措施；将 ICU中 2024年 2—7月接受机械通气的病人 88例归为观察组，实施 PDCA循环管理防控措施，比较两组 VAP发生情况。结果未 VAP组与 VAP组年龄 ≥60岁［54.03%(67/124)比 74.19%(46/62)］、 ICU住院时长 >14 d［8.06%(10/124)比 24.19%(15/62)］、机械通气时长 >5 d［62.10%(77/124)比83.87%(52/62)］、意识障碍［30.65%(38/124)比 51.61%(32/ 62)］、胃内容物反流［14.52%(18/124)比 27.42%(17/62)］、抑酸剂使用时长 >3 d［47.58%(59/124)比 70.97%(44/62)］、留置胃管［58.06%(72/124)比 75.81%(47/62)］、急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)评分 ≥15分［43.55%(54/124)比 61.29%(38/62)］、抗菌药物联合使用［41.94%(52/124)比 64.52%(40/62)］、预防性抗生素使用［39.52%(49/124)比 61.29%(38/62)］、低蛋白血症［33.06%(41/124)比 56.45%(35/62)］差异有统计学意义( P<0.05)。 logistic回归分析显示:年龄 ≥60岁、 ICU住院时长 > 14 d、机械通气时长 >5 d、意识障碍、抑酸剂使用时长 >3 d、APACHEⅡ评分 ≥15分、抗菌药物联合使用、预防性抗生素使用、低蛋白血症是 ICU病人发生 VAP的独立危险因素( P<0.05)。ROC曲线分析显示:年龄、机械通气时长、意识障碍、抑酸剂使用时长、 APACHEⅡ评分、抗菌药物联合使用、预防性抗生素使用、低蛋白血症及联合预测对于预测 ICU病人发生 VAP均差异有统计学意义( P<0.05)其中联合预测的曲线下面积(AUC)为 0.86，95%CI为(0.81，0.91)灵敏度为 0.95，特异度为 0.59。观察组的 VAP发生率［2.27%(2，/88)］、 VAP千日发生率［2.07‰(2/967)］均显著低于对照组［9.47，%(9/95)、 8.71‰(9/1 033)］(P<0.05)。结论 年龄 ≥60岁、 ICU住院时长 >14 d、机械通气时长 >5 d、意识障碍、抑酸剂使用时长 >3 d、APACHEⅡ评分 ≥15分、抗菌药物联合使用、预防性抗生素使用、低蛋白血症是 ICU病人发生 VAP的独立危险因素，而 PDCA循环管理干预效果良好，可有效减少 VAP发生，值得推广运用。 |
| 英文摘要: |
| Objective To explore the risk factors for ventilator-associated pneumonia (VAP) in the intensive care unit (ICU) and the effects of management interventions based on the Plan-Do-Check-Act (PDCA) cycle.Methods Sixty-two patients with VAP developedin the ICU of Jiaozhou Central Hospital in Qingdao from February 2021 to January 2024 were selected as the VAP group, and another124 patients who received mechanical ventilation in the ICU during the same period but did not develop VAP were selected as the non-VAP group. Clinical data of both groups were gathered. The risk factors were analyzed using a logistic regression model, and the receiv.er operating characteristic curve (ROC curve) was created using the probability values derived from the regression equation. Further.more, 95 patients in this hospital's ICU from August 2023 to January 2024 were considered the control group and were administeredroutine prevention and control measures; 88 patients in the ICU from February 2024 to July 2024 were considered the observationgroup and were administered PDCA cycle management. The occurrence of VAP in both groups was compared.Results There were sta. tistically significant differences between the non-VAP group and the VAP group in terms of age ≥60 years [54.03% (67/124) vs. 74.19% (46/62)], ICU hospital stay >14 d [8.06% (10/124) vs. 24.19% (15/62)], mechanical ventilation duration >5 d [62.10% (77/124) vs. 83.87% (52/62)], consciousness disturbance [30.65% (38/124) vs. 51.61% (32/62)], gastric content reflux [14.52% (18/124) vs. 27.42% (17/62)], duration of acid suppressant use>3 d [47.58% (59/124) vs. 70.97% (44/62)], indwelling gastric tube [58.06% (72/124) vs. 75.81% (47/62)], acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥15 points [43.55% (54/124) vs. 61.29% (38/ 62)], combined use of antibiotics [41.94% (52/124) vs. 64.52% (40/62)], prophylactic antibiotic use [39.52% (49/124) vs. 61.29% (38/ 62)], and hypoproteinemia [33.06% (41/124) vs. 56.45% (35/62)] (P<0.05). Logistic regression analysis showed that age ≥60 years, ICUstay >14 d, mechanical ventilation duration >5 d, consciousness disturbance, duration of acid suppressant use >3 d, APACHE Ⅱscore ≥15 points, combined use of antimicrobial drugs, prophylactic antibiotic use, and hypoalbuminemia were independent risk factorsfor VAP in ICU patients (P<0.05). ROC curve analysis showed that age, mechanical ventilation duration, consciousness disturbance, use of acid-suppressing agents, APACHE Ⅱ score, combined use of antimicrobial drugs, prophylactic antibiotic use, hypoalbuminemia,and combined prediction all had statistical significance in predicting VAP in ICU patients (P<0.05); among them, the area under the curve (AUC) of combined prediction was 0.86 [95%CI: (0.81, 0.91)], demonstrating a sensitivity of 0.95 and a specificity of 0.59. The in. cidence of VAP [2.27% (2/88) vs. 9.47% (9/95)] and the incidence of VAP per 1,000 days in the observation group [2.07‰ (2/967) vs. 8.71‰ (9/1 033)] were substantially lower than those in the control group (P<0.05).Conclusions Age ≥60 years, ICU stay >14 days,mechanical ventilation duration>5 days, consciousness disturbance, duration of acid suppressant use >3 days, APACHE Ⅱ score ≥15, combined use of antimicrobial drugs, prophylactic antibiotic use, and hypoalbuminemia are independent risk factors for VAP in ICU pa.tients. The PDCA cycle management intervention is effective and can significantly reduce the occurrence of VAP, which is worth pro.moting and applying. |
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