摘要
目的探讨鲍曼不动杆菌感染对行气管插管呼吸机辅助通气治疗的脑血管病患者预后的影响。方法选取2015—2017年在济宁医学院附属医院ICU行气管插管呼吸机辅助通气治疗的脑血管病患者64例,根据气管插管后痰培养结果分为非鲍曼不动杆菌感染者41例(对照组)和鲍曼不动杆菌感染者23例(感染组)。回顾性分析两组患者的临床资料,行气管插管呼吸机辅助通气治疗的脑血管病患者预后的影响因素分析采用多因素Logistic回归分析。结果两组患者机械通气时间、住ICU时间比较,差异无统计学意义(P>0.05);感染组患者病死率高于对照组(P<0.05)。不同预后患者年龄、性别、格拉斯哥昏迷量表(GCS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、行颅脑手术者所占比例、插管前使用抗生素者所占比例、治疗期间使用激素者所占比例、真菌感染发生率、低蛋白血症发生率及鲍曼不动杆菌多重耐药者所占比例比较,差异无统计学意义(P>0.05);存活者休克、血流感染及鲍曼不动杆菌感染发生率低于死亡者(P<0.05)。多因素Logistic回归分析结果显示,休克[OR=1.935,95%CI(1.031,3.630)]和鲍曼不动杆菌感染[OR=19.395,95%CI(1.376,273.418)]是行气管插管呼吸机辅助通气治疗的脑血管病患者预后不良的独立危险因素(P<0.05)。结论鲍曼不动杆菌感染是行气管插管呼吸机辅助通气治疗的脑血管病患者预后不良的独立危险因素,应引起临床重视。
Objective To investigate the impact of Acinetobacter baumannii infection on prognosis in cerebrovascular disease patients undergoing endotracheal intubation and ventilator assisted ventilation. Methods From 2015 to 2017,a total of 64 cerebrovascular disease patients undergoing endotracheal intubation and ventilator assisted ventilation were selected in Intensive Care Unit,the Affiliated Hospital of Jining Medical University,and they were divided into control group(did not complicate with Acinetobacter baumannii infection,n=41)and infection group(complicated with Acinetobacter baumannii infection,n=23)according to the sputum culture results after endotracheal intubation. Clinical data in the two groups was retrospectively analyzed,and multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in cerebrovascular disease patients undergoing endotracheal intubation and ventilator assisted ventilation. Results No statistically significant differences of duration of mechanical ventilation or ICU stays was found between the two groups(P>0.05);while fatality rate in infection group was statistically significantly higher than that in control group(P<0.05). No statistically significant differences of age,gender,GCS score,APACHE Ⅱ score,proportion of patients undergoing craniocerebral operation,using antibiotics before endotracheal intubation or using glucocorticoids during treatment,incidence of fungal infection or hypoproteinemia,proportion of patients with multiple drug resistance of Acinetobacter baumannii was found in patients with different prognosis(P>0.05);incidence of shock,bloodstream infection and Acinetobacter baumannii infection during treatment in survived patients was statistically significantly lower than that in dead patients,respectively(P<0.05). Multivariate Logistic regression analysis results showed that,shock[OR=1.935,95%CI(1.031,3.630)]and Acinetobacter baumannii infection[OR=19.395,95%CI(1.376,273.418)]during treatment were independent risk factors of poor prognosis in cerebrovascular disease patients undergoing endotracheal intubation and ventilator assisted ventilation(P<0.05). Conclusion Acinetobacter baumannii infection during treatment is one of independent risk factors of poor prognosis in cerebrovascular disease patients undergoing endotracheal intubation and ventilator assisted ventilation,which should pay attention to on clinic.
引文
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