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中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (04) : 209 -215. doi: 10.3877/cma.j.issn.2095-8773.2016.04.04

所属专题: 文献

论著

体外膜肺氧合支持治疗患者的感染危险因素分析
孙各琴1, 李斌飞1,(), 叶子1, 李素芬1, 杨皓程1, 冯雪琴1, 严海忠1, 罗锡华1, 慕月晶1   
  1. 1. 528400 广州,中山大学附属中山市人民医院检验医学中心
  • 收稿日期:2016-06-28 出版日期:2016-11-28
  • 通信作者: 李斌飞

Infection factors for patients treated with extracorporeal membrane oxygenation

Geqin Sun1, Binfei Li1,(), Zi Ye1, Sufen Li1, Haocheng Yang1, Xueqin Feng1, Haizhong Yan1, Xihua Luo1, Yuejing Mu1   

  1. 1. Center of Medical Examination, Zhongshan People's Hospital Affiliated to Sun Yat-sen University, Zhongshan 528400, China
  • Received:2016-06-28 Published:2016-11-28
  • Corresponding author: Binfei Li
  • About author:
    Corresponding author: Li Binfei, Email:
引用本文:

孙各琴, 李斌飞, 叶子, 李素芬, 杨皓程, 冯雪琴, 严海忠, 罗锡华, 慕月晶. 体外膜肺氧合支持治疗患者的感染危险因素分析[J/OL]. 中华胸部外科电子杂志, 2016, 03(04): 209-215.

Geqin Sun, Binfei Li, Zi Ye, Sufen Li, Haocheng Yang, Xueqin Feng, Haizhong Yan, Xihua Luo, Yuejing Mu. Infection factors for patients treated with extracorporeal membrane oxygenation[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(04): 209-215.

目的

分析体外膜肺氧合(ECMO)支持患者的医院感染因素。

方法

收集广东省中山市人民医院2009年1月至2014年3月行ECMO支持患者的医院感染资料,并进行回顾性分析。

结果

75例患者中发生医院感染20例,感染率26.7%。分离病原菌58株,其中革兰阴性菌43株(74.1%),革兰阳性菌15株(25.9%)。多重耐药菌株高度集中,以鲍曼不动杆菌(21株,36.2 %)、铜绿假单胞菌(18株,31.0 %)和凝固酶阴性葡萄球菌(11株,20.0 %)为主。感染组平均住院时间为36.5 d,显著长于非感染组的7.0 d,差异有统计学意义(Z=-2.090,P<0.05);感染组ECMO支持时间>48 h者占95.0%,显著高于非感染组的52.7%,差异也有统计学意义(χ2=11.375,P=0.001)。ECMO支持时间延长会延长住院时间,但未增加病死率;高水平乳酸增加患者的病死率(Z=-2.598,P<0.05)。

结论

行ECMO支持治疗继发感染与住院时间、ECMO支持时间有明显相关性,医院应对此作出相应的预防措施,减少ECMO继发感染的发生。

Objective

To analyze the factors of hospital infection for patients treated with extracorporeal membrane oxygenation(ECMO).

Methods

The clinical data on hospital infection of patients undergoing ECMO support between January 2009 and March 2014 in Zhongshan People's Hospital of Guangdong Province were collected and retrospectively analyzed.

Results

There were 20 cases of hospital infection among 75 cases, with the infection rate of 26.7%. A total of 58 strains of pathogen were isolated, among which 43(74.1%) were Gram-negative and 15(25.9%) were Gram-positive. Acinetobacter baumannii(21 strains, 36.2%), Pseudomonas aeruginosa(18 strains, 31.0%) and coagulase-negative Staphylococci(11 strains, 20.0%) dominated multi-resistant strains. The mean hospitalization duration in infection group was significantly longer than that in non-infection group (36.5 d vs 7.0 d, Z=-2.090, P<0.05). The percent of patients with ECMO support time>48 h in infection group was 95.0%, and was significantly longer than that in non-infection group(52.7%)(χ2=11.375, P=0.001). Extended ECMO support increased the length of hospital stay, but did not increase the mortality. High levels of lactic acid increased the mortality of patients (Z =-2.598, P < 0.05).

Conclusions

Infection secondary to ECMO support is significantly related to hospital stay and ECMO support time. The hospital should take preventive measures to reduce the infection secondary to ECMO.

表1 ECMO支持感染患者的危险因素分析
表2 ECMO感染患者的主要病原菌药敏情况(%)
表3 ECMO支持治疗继发感染的患者的特点[n(%)]
表4 主要病原菌的耐药表型
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