摘要
目的探讨机械通气患者发生肺来源性鲍曼不动杆菌（AB）血流感染（BSI）的危险因素。方法采用回顾性观察性研究方法，分析广州医科大学附属第一医院广州呼吸疾病研究所重症医学科2011年1月至2015年12月5年内收治的发生AB肺炎需要进行气管插管机械通气患者的临床资料，根据是否发生肺来源性BSI将患者分为无BSI组和BSI组。比较两组患者的性别、年龄、人重症加强治疗病房（ICU）时急性生理学与慢性健康状况评分系统Ⅱ（APACHEII）评分、临床肺部感染评分（CPIS）、基础疾病、是否出现粒细胞减少或缺乏、是否咳血、3个月内是否全身使用过激素或免疫抑制剂治疗、是否留置中心静脉导管（CVC）、是否使用胃肠外营养（PN）、诊断AB肺炎后是否联合使用抗菌药物治疗、机械通气时间和AB耐药性，并进行logistic逐步回归分析，筛选出机械通气AB肺炎患者发生肺来源性BSI的独立高危因素。结果共入选612例患者，其中无BSI组561例，BSI组51例，5年内AB-BSI发生率为8．3％。两组间性别、年龄差异无统计学意义。BSI组APACHEⅡ评分（分：20．8±9．2比17．3±5．5）和CPIS评分（分：7．1±3．9比5．6±1．6）均较无BSI组显著升高（均P〈0．05）。BSI组患者中CPIS〉6分[80．4％（41／51）比28．0％（157／561）]、慢性阻塞性肺疾病[COPD，86．3％（44／51）比46．7％（262／561）]、糖尿病[DM，25．5％（13／51）比14．8％（83／561）]的比例较无BSI组显著升高，而心力衰竭的比例（HF，5．9％（3／51）比23．5％（132／561）．]则较无BSI组显著降低，出现咳血症状[27．4％（14／51）比3．4％（19／561）]、全身使用激素或免疫抑制剂治疗（19．6％（10／51）比7．8％（44／561）]及机械通气〉14d[80．4％（41／51）比48．5％（272／561）]的比例也较无BSI组显著升高（均P〈O．05）；而性别、年龄、
[Abstract] Objective To investigate the high risk factors for pneumonia-related bloodstream infection （BS1） caused by Acinetobacter baumannii （AB） in ventilated patients. Methods A retrospective observation was conducted. The data of invasive-ventilated patients underwent AB pneumonia admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2015 were enrolled. The patients were divided into non-AB-BSI group and AB-BSI group. The following factors were evaluated including gender, age, acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ ） score at admission of intensive care unit （ICU）, clinic pulmonary infection score （CPIS）, underlying disease, neutropeniaor agranuioeytosis, hemoptysis, treatment of steroid or immunosuppressant in recent 3 months, central venous catheter （CVC）, parenteral nutrition （PN）, combined antibiotic therapy after the diagnose of AB pneumonia, duration of mechanical ventilation and the resistance of AB. The risk factors were analyzed by logistic regression analysis to confirm the independent high risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Results 612 patients were enrolled, 561 patients in non-BSI group, and 51 in BSI group with 5-year BSI incidence of 8.3%. There was no significant difference in gender or age between the two groups. Compared with non-BSI group, the APACHE Ⅱ score （20.8 ± 9.2 vs. 17.3 ±5.5） and CPIS （7.1 ± 3.9 vs. 5.6 ± 1.6） in BSI group were significantly increased （both P 〈 0.05）. The patients with CPIS 〉 6 [80.4% （41/51） vs. 28.0% （157/561）], chronic obstructive pulmonary diseases [COPD, 86.3% （44/51） vs. 46.7% （262/561）], diabetes mellitus [DM, 25.5% （13/51） vs. 14.8% （83/561）] in BSI group were more than patients in non-BSI group, the incidence of heart failure [HF, 5.9% （3/51） vs. 23.5% （132/561）] was significan
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第6期487-491,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金（81270125）
关键词
机械通气
鲍曼不动杆菌
血流感染
肺疾病
阻塞性
慢性
临床肺部感染评分
Mechanical ventilation
Acinetobacter baumannii
Bloodstream infection
Chronic obstructivepulmonary disease
Clinic pulmonary infection score
