ارزیابی پنومونی وابسته به ونتیلاتور زودرس و دیررس در بیماران بستری به علت جراحی‌های اعصاب

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه بیهوشی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: پنومونی وابسته به ونتیلاتور (Ventilator-associated pneumonia یا VAP)، از جمله شایع‌ترین علل مرگ و میر بیماران بستری در بخش مراقبت‌های ویژه (Intensive care unit یا ICU) است. مطالعات اندکی در زمینه‌ی انواع VAP در بیمارانی که به علت جراحی‌های اعصاب تحت ونتیلاسیون قرار گرفته‌اند، انجام شده است؛ در حالی که احتمال VAP در این دسته از بیماران به دلیل خطر آسپیراسیون اوروفارنژیال (Oropharyngeal aspiration یا OPA) به دنبال آسیب مغزی زیاد است. هدف از انجام پژوهش حاضر، بررسی اتیولوژی انواع VAP زودرس و دیررس در بیماران تحت جراحی‌های اعصاب بود.روش‌ها: این مطالعه‌ی‌ مقطعی، بر روی 82 بیمار مبتلا به VAP به دنبال انجام جراحی‌های اعصاب صورت گرفت. اطلاعات بیماران با استفاده از چک‌لیستی شامل اطلاعات دموگرافیک، نوع VAP (زودرس/ دیررس)، امتیاز Acute Physiology and Chronic Health Evaluation II (APACHE II)، نمره‌ی Clinical Pulmonary Infection Score (CPIS)، علت جراحی مغز و اعصاب، سابقه‌ی بیماری گذشته، مصرف دخانیات، نتایج اسمیر و کشت و آنتی‌بیوگرام بیماران ثبت گردید و مورد تجزیه و تحلیل قرار گرفت.یافته‌ها: ارتباط معنی‌داری بین نوع VAP با سن (560/0 = P)، جنسیت (270/0 = P)، علت جراحی (960/0 = P) و سابقه‌ی بیماری (930/0 = P) وجود نداشت، اما ارتباط معنی‌داری بین نوع VAP با تعداد روز بستری (034/0 = P)، مصرف دخانیات (001/0 > P)، امتیاز APACHE بدو ورود (001/0 > P) و نمره‌ی CPIS (001/0 > P) مشاهده شد. تعداد روز بستری [040/0 = P، 04/35-1/21 = Confidence interval 95% (CI95%)، 71/4 = Odds ratio (OR)] و مصرف دخانیات (015/0 = P، 01/14-1/1 = CI95%، 07/1 = OR) به طور مستقل با ابتلا به VAP مرتبط بود. ارتباط معنی‌داری بین نوع VAP با رنگ‌آمیزی گرم (330/0 = P) و آنتی‌بیوگرام (140/0 = P) نمونه‌ها یافت نشد.نتیجه‌گیری: بر اساس نتایج مطالعه‌ی‌ حاضر، تعداد روز بستری، مرگ و میر، مصرف دخانیات، امتیاز APACHE و نمره‌ی CPIS به صورت معنی‌داری در VAP دیررس بالاتر می‌باشد. همچنین، تعداد روز بستری و مصرف دخانیات در ابتلا به VAP بدون در نظر گرفتن نوع آن، مؤثر بود. الگوی میکروبی بیماران ارتباطی با ابتلا به VAP دیررس/ زودرس نداشت.

کلیدواژه‌ها

عنوان مقاله [English]

Assessment of Early- and Late-Onset Ventilator-Associated-Pneumonia in Patients Admitted for Neurosurgical Procedures

نویسندگان [English]

  • Ali Hajigholami-Saryazdi 1
  • Sayed Taghi Hashemi 2
  • Babak Alikiaii 2
  • Vahid Taherpour 3
1 Assistant Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Ventilator-associated pneumonia (VAP) is among the most common etiologies of mortality in intensive care unit (ICU). Studies about VAP among patients under mechanical ventilation admitted for neurosurgery procedures are limited while probability of VAP among these patients is high, because of oropharyngeal aspiration following brain injury. In the current study, the etiology of early- and late-onset VAP was assessed among the patients admitted for neurosurgical procedures.Methods: Current cross-sectional study was conducted on 82 patients with VAP following neurosurgical procedure. Information about patients including demographics, early/late-onset VAP, the score of Acute Physiology and Chronic Health Evaluation II (APACHE II), Clinical Pulmonary Infection Score (CPIS), underlying reason of neurosurgical procedure, medical history, smoking history, and smear/culture, and antibiograms were recorded and analyzed.Findings: VAP type was not in association with age (P = 0.560), gender (P = 0.270), etiology of neurosurgery (P = 0.960), and medical history (P = 0.930), but was statistically in association with admission duration (P = 0.034), smoking (P < 0.001), APACHE II score (P < 0.001), and CPIS score (P < 0.001). Duration of admission [odds ratio (OR) = 4.71; confidence interval of 95% (95%CI): 1.04-21.35; P = 0.040) and smoking (OR = 1.07; 95%CI: 1.01-1.14; P = 0.015) were independently in association with VAP. There was no association between type of VAP and Gram staining (P = 0.330) and antibiogram (P = 0.140).Conclusion: Based on the current study, duration of admission, mortality, smoking, APACHE II score, and CPIS score were significantly higher among late-onset VAP. Moreover, admission duration and smoking was independently in association with VAP regardless of its type. The microbial pattern was not in association with late/early-onset VAP.

کلیدواژه‌ها [English]

  • Ventilator-associated pneumonia
  • Neurosurgical procedures
  • Intensive Care Unit

مراجع

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مجله دانشکده پزشکی اصفهان
دوره 37، شماره 515 - شماره پیاپی 515
فروردین و اردیبهشت 1398
صفحه 73-79

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سابقه مقاله

  • تاریخ دریافت: 21 مهر 1397
  • تاریخ بازنگری: 05 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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