探讨重症手足口病(HFMD)机械通气后并发呼吸机相关性肺炎(VAP)的危险因素。

收集2009年3月至2012年4月，本院儿科重症监护室(PICU)收治的使用呼吸机时间>48 h的重症HFMD患儿142例为研究对象，按照有无合并VAP，将其分为2组，VAP组(n＝64，并发VAP)和对照组(n＝78，未并发VAP)。2组患儿的性别、年龄、体重、病情程度等比较，差异无统计学意义(P>0.05)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意)。以年龄、性别、机械通气时间、合并贫血、合并营养不良、机械通气过程中是否再插管、机械通气时间、频繁气管内吸引、合并肺出血、合并呼吸道免疫功能低下、是否预防性使用抗菌药物等为预想危险因素进行单因素及非条件多因素logistic分析，探讨各危险因素与VAP的相关性。

VAP组与对照组患儿病死率分别为12.50% (8/64)，3.85%(3/78)，2组比较，差异有统计学意义(χ²＝3.88, P<0.05)。非条件多因素logistic回归分析显示，各危险因素在重症HFMD患儿发生VAP中的顺序依次为：机械通气过程中是否再插管、机械通气时间、频繁气管内吸引、合并肺出血、合并呼吸道免疫功能低下，但预防性使用抗菌药物为保护性因素。

重症HFMD患儿机械通气后并发VAP发生率较高，相关危险因素多，采取针对性防治措施可能是控制VAP的最佳方案。

To explore high risk factors of ventilator-associated pneumonia (VAP) in severe hand-foot-mouth disease (HFMD) patients.

A retrospective study was conducted in 142 serious HFMD patients who had mechanical ventilation≥48 h from March 2009 to April 2012. They were divided into two groups according to whether they suffered VAP nor not, VAP group (n=64, patients suffered from VAP) and control group (n=78, patients without VAP). There had no significant differences between two groups on gender, age, weight and degrees of HFMD (P>0.05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of First People's Hospital of Yichun. Informed consent was obtained from all participates' parents. Single-factor analysis with Chi-square test and non-conditional multi-factor logistic regression were performed to determine risk factors, such as age, gender, duration of mechanical ventilation, reintubation, duration of mechanical ventilation, frequency of airway suctioning, pulmonary hemorrhage, poor respiratory immune function, and so on.

The mortality of two groups were 12.50%(8/64), 3.85%(3/78), respectively. There had significant difference between two groups (χ²=3.88, P<0.05). By multi-factor logistic regression analysis, the risk factors in the role of VAP happened for the order size were reintubation, duration of mechanical ventilation, frequency airway suctioning, pulmonary hemorrhage, poor respiratory immune function. The usage of antibiotic was a protection factor in preventing from VAP.

Incidence rate of VAP in HFMD is high, with many risk factors. And specific preventive countermeasures and cure treatments may be the best way to manage VAP.