摘要
目的了解ICU内中心静脉导管相关性血行性感染(CLABSI)患者预后的危险因素与住院费用。方法对2006年6月至2009年6月综合ICU内阳性血培养的流行情况进行回顾性调查,筛选CLABSI患者,按照临床转归比较生存与死亡患者的生理与实验室参数,同时对输血、机械通气事件及住院费用等指标进行考察,预后危险因素筛查采用Logistic回归分析。结果 3年间ICU内共诊断49例CLABSI患者,死亡19例(38.8%),生存30例(61.2%)。单因素分析显示死亡组与生存组的体温、中心静脉压、APACHEⅡ评分、输血量、血pH、D-二聚体、血清丙氨酸转氨酶、血清尿素氮、血清肌酐和血清钾等指标有显著性差异(P均<0.05);两组在总住院时间、ICU住院时间及对应的每日住院费用方面未见显著差异(P均>0.05)。Logistic多元回归分析显示APACHEⅡ(OR0.78,95%CI0.66～0.94;P=0.007)、活化部分凝血活酶时间(APTT)(OR0.87,95%CI0.77～0.98;P=0.026)及血钾水平(OR0.09,95%CI0.01～0.80;P=0.031)为ICU内CLABSI预后的独立预后危险因素。结论 ICU内CLABSI患者的预后与发病时的病情程度以及出、凝血功能有直接联系。目前资料并未提示不同预后CLABSI的患者住院时间与相应费用存在差异。
Objective To investigate the prognostic factors and hospitalization cost in patients diagnosed as central line-associated bloodstream infection（CLAbsI） in intensive care unit（ICU）.Methods A retrospective study was made to investigate the CLAbsI epidemic data in ICU from June 2006 to June 2009.Clinical and physiological parameters were summarized and compared between these patients,which were divided into two groups based on the clinical outcome.Meanwhile,events including blood transfusion,mechanical ventilation,as well as cost of hospitalization were also reviewed.Logistic regression method was introduced to investigate the potential prognostic risk factors.Results There were 49 patients were diagnosed as nosocomial CLAbsI,in which 19 cases（38.8%） died in the hospital and 30（61.2%） were survival.In univariate analysis,differences in body temperature,central venous pressure,acute physiology and chronic health evaluation（APACHEⅡ） score,blood transfusion amount,pH value,D-dimer,blood serum alanine transarninase,blood urea nitrogen level,serum creatinine,serum potassium between the survivors and the non-survivors were significant（P0.05）.However,no significant differences were observed between the two groups in in-hospital days,ICU days and hospitalization cost（all P0.05）.With multiple logistic regressions,higher APACHEⅡ score（OR 0.78;95% confidence interval：0.66-0.94;P=0.007）,APTT level（OR 0.87;95% confidence interval：0.77-0.98;P=0.026） and serum potassium（OR 0.09;95% confidence interval：0.01-0.80;P=0.031） were independent predictors of worse outcome.Conclusions Disease severity and coagulation situation may directly predict the prognosis of nosocomial CLAbsI patients.But current investigation did not demonstrate significant differences in ICU length of stay and respective cost between the CLAbsI patients with different prognosis.
出处
《中国呼吸与危重监护杂志》
CAS
2010年第3期239-242,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
医院感染
血行性感染
败血症
预后因素
重症加强治疗
Nosocomial infection
Blood stream infections
Bacteremia
Prognostic factors
Intensive care
