目的　探讨儿童重症监护病房（PICU）发生呼吸机相关性肺炎（VAP）的危险因素。方法　回顾分析2014年6 月至2017年6月入住PICU且临床检查资料完整的455例患儿的临床资料。根据有无发生VAP将患儿分为VAP组和非VAP组， 比较分析VAP 发生的危险因素。结果　455例患儿中男311例、女144例，中位年龄11个月，其中发生VAP 43例，发生率 为9.45%。发生VAP 患儿的原发病最常见为先天性喉气管发育畸形合并肺部感染（23.3%），其次为先天性心脏病合并肺 部感染（18.6%）。 单因素分析提示，与非VAP 组相比，VAP 组患儿经口气管插管和再插管以及全部肠外营养的比例较高， 机械通气时间长，差异均有统计学意义（P<0.05）；多因素非条件logistic回归分析显示，气管插管类型（经口）（ OR=1.87， 95%CI：1.48~ 9.75）、机械通气时间（OR=1.14，95%CI：1.08~2.35）、再插管（OR=3.42，95%CI：1.26~5.57）、早期用 抗生素（OR=4.55，95%CI：2.21~8.77）均为影响VAP发生的独立危险因素。结论　PICU患儿发生VAP的危险因素较多， 综合评价和合理使用抗菌药物等措施可减少VAP。

Objectives　To determine the risk factors of ventilator-associated pneumonia (VAP) in the pediatric intensive care unit and to explore effective strategies to reduce the morbidity of VAP. Methods　A retrospective analysis was conducted on 455 children admitted into the PICU of Hunan Children's Hospital from June 2014 to June 2017. The 455 children were divided into VAP group (n=43) and non-VAP group (n=412). The incidence of VAP was identified and risk factors were compared using the logistic regression analysis via SPSS 19.0 software. Results　There were 311 males and 144 females with a median age of 11 months old (29 days to 9 years and 4 months). The incidence of VAP was 9.45% (43/455). Congenital laryngeal and trachea malformation with pulmonary infection was the first reason for the occurrence of VAP (23.3%), followed by congenital heart diseases with pulmonary infection (18.6%). Via univariate analysis, types of endotracheal intubation (χ2=45.33, P＜0.001), duration of mechanical ventilation (Z=1.21, P=0.034), re-intubation (χ2=20.22, P=0.004), early usage of antibiotics (χ2=4.98, P=0.026), and methods of nutritional support (χ2=10.15, P=0.006) were identified as risk factors of VAP in the pediatric intensive care unit patients (P＜0.05). Based on the multivariate logistic regression analysis, the followings were all independent predictor for VAP: types of endotracheal intubation (OR=1.87, 95%CI:1.48~9.75), duration of mechanical ventilation (OR=1.14, 95%CI:1.08~2.35), re-intubation (OR=3.42, 95%CI:1.26~5.57), early usage of antibiotics (OR=4.55, 95%CI:2.21~8.77). Conclusions　Many risk factors were found related with the occurrence of VAP. A comprehensive analysis of the host factors and iatrogenic factors should be conducted. Rational use of antibiotics and daily assessment of extubation might help reduce the incidence of VAP.