神经外科病人血流感染危险因素分析
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摘要
目的探讨神经外科病人发生血流感染的危险因素。方法回顾性分析2014年6月至2018年1月神经外科收治的1573例病人的临床资料,采用多因素Logistic回归分析检验危险因素。结果 1 573例中,发生血流感染126例,感染率为8.01%。126例血培养标本检出142株致病菌,其中革兰阳性菌68株(47.89%),革兰阴性菌72株(50.70%),真菌2株(1.41%)。多因素Logistic分析显示,深静脉置管、气管切开机械通气、留置导尿、使用糖皮质激素、血清降钙素原>0.5 ng/ml、血溏>11.1 mmol/L是神经外科病人发生血流感染的独立危险因素(P<0.05)。结论做好评估,减少不必要的侵入性诊疗;合理使用糖皮质激素,控制血糖;监测降钙素原早期预测与干预可能是减少神经外科血流感染的有效措施。
Objective To investigate the characteristics and risk factors of blood stream infection in Department of neurosurgery.Methods The clinical data of 1 573 neurosurgical patients treated from June, 2014 to January, 2018 were analyzed retrospectively.Results The blood stream infection rate was 8.01% in 1 573 neurosurgical patients. The univariate analysis showed that the factors related to the neurosurgical patients' bloodstream infection included the patients' age, history of diabetes, admission to ICU, APACHEⅡ score, deep vein catheterization, coma, tracheotomy, indwelling bladder catheter, administration of glucocorticoid, blood glucose,peripheral blood leukocytes, percentage of peripheral blood neutrophils, and serum levels of C-reactive protein and procalcitonin(P<0.05). The multivariate logistic analysis showed that the independent risk factors of the neurosurgical patients' bloodstreams infection included the deep venous catheterization, mechanical ventilation, indwelling bladder catheter, administration of glucocorticoid, serum procalcitonin >0.5 ng/ml, and blood glucose >11.1 mmol/L(P<0.05). Conclusion The main measures to reduce neurosurgical patients' bloodstream infection should include the correct assessment of disease condition, reduction of unnecessary invasive methods of the diagnosis and treatment, rational administrastion of glucocorticoid, control of the blood sugar, monitoring of the serum procalcitonin, and early prevention and treatment of the bloodstreams infection.
Objective To investigate the characteristics and risk factors of blood stream infection in Department of neurosurgery.Methods The clinical data of 1 573 neurosurgical patients treated from June, 2014 to January, 2018 were analyzed retrospectively.Results The blood stream infection rate was 8.01% in 1 573 neurosurgical patients. The univariate analysis showed that the factors related to the neurosurgical patients' bloodstream infection included the patients' age, history of diabetes, admission to ICU, APACHEⅡ score, deep vein catheterization, coma, tracheotomy, indwelling bladder catheter, administration of glucocorticoid, blood glucose,peripheral blood leukocytes, percentage of peripheral blood neutrophils, and serum levels of C-reactive protein and procalcitonin(P<0.05). The multivariate logistic analysis showed that the independent risk factors of the neurosurgical patients' bloodstreams infection included the deep venous catheterization, mechanical ventilation, indwelling bladder catheter, administration of glucocorticoid, serum procalcitonin >0.5 ng/ml, and blood glucose >11.1 mmol/L(P<0.05). Conclusion The main measures to reduce neurosurgical patients' bloodstream infection should include the correct assessment of disease condition, reduction of unnecessary invasive methods of the diagnosis and treatment, rational administrastion of glucocorticoid, control of the blood sugar, monitoring of the serum procalcitonin, and early prevention and treatment of the bloodstreams infection.
引文
[1]魏忠梅,段永暖,张丽贞,等.家庭赋权干预对神经外科危重病人医院感染预防效果的研究[J].中华医院感染学杂志,2016,26(4):939-941.
[2] Harron K, Mok Q, Hughes D, et al. Generalisability and cost-impact of antibiotic-impregnated central venous catheters for reducing risk of bloodstream infection in Paediatric Intensive Care Units in England[J]. PLoS One,2016, 11(3):e0151-348.
[3]苟茹萍,赵兰菊,徐翠莲.重症病人发生血液感染的相关危险因素及对策[J].吉林医学,2017,38(8):1561-1562.
[4] Zhang P, Yang Y, Lv R, et al. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury:a single-center randomized clinical trial[J]. Nephrol Dial Transplant, 2012, 27(3):967-973.
[5]赵素民,赵贵锋,陈峰,等.神经外科重症监护病房病人中心静脉导管相关血液感染病原菌分析[J].中国感染与化疗杂志,2017,17(6):629-632.
[6]张艳君,马秀珍,秦琴,等.血液感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017,17(3):314-320.
[7]李元,朱曦,江智霞,等.白血病病人PICC相关性血液感染目标性监测及危险因素分析[J].中华医院感染学杂志,2017,27(20):4622-4625.
[8]苟茹萍,赵兰菊,徐翠莲.重症病人发生血液感染的相关危险因素及对策[J].吉林医学,2017,38(8):1561-1562.
[9] Olaechea PM, Palomr M, lvarez-Lerma F, et al. Morbidiity and mortality associated with primary and catheter-related bloodstream infedtions in critically ill patients[J]. Rev Esp Quimioter, 2013, 26(1):21-29.
[10]汪彦,朱伦刚,蒋忠洋,等.血清降钙素原水平和APACHEⅡ评分动态变化对血液感染病人预后评估价值的分析[J].检验医学与临床,2016,13(9):1243-1245.
[11] Tao F, Jiang R, Chen Y, et al. Risk factors for early onset of catheter-related blood stream in fection in an intensive care unit in China:a retrospective study[J]. Med Sci Monit,2015, 21:550-556.
[12]赵凤容,陆水英,张秀渝,等.多重耐药鲍曼不动杆菌感染危险因素分析[J].检验医学与临床,2014,(10):1310-1312.
[13] Bloos F, Reinhart K. Rapid diagnosis of sepsis[J]. Virulence, 2014, 5(1):154-160.
[14]冯雪琴,吴润洁,卢兰芬,等.降钙素原、超敏C反应蛋白、白细胞介素6、白细胞联合检测在2型糖尿病血液感染诊断中的应用[J].国际检验医学杂志,2018,39(2):169-175.
[15]姚淑雯,王淑香,叶家骏,等.降钙素原、白细胞、中性粒细胞比率、C反应蛋白及血小板在早期成人细菌性脓毒症中的应用比较[J].广东医学,2017,38(A1):133-134,137.
[2] Harron K, Mok Q, Hughes D, et al. Generalisability and cost-impact of antibiotic-impregnated central venous catheters for reducing risk of bloodstream infection in Paediatric Intensive Care Units in England[J]. PLoS One,2016, 11(3):e0151-348.
[3]苟茹萍,赵兰菊,徐翠莲.重症病人发生血液感染的相关危险因素及对策[J].吉林医学,2017,38(8):1561-1562.
[4] Zhang P, Yang Y, Lv R, et al. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury:a single-center randomized clinical trial[J]. Nephrol Dial Transplant, 2012, 27(3):967-973.
[5]赵素民,赵贵锋,陈峰,等.神经外科重症监护病房病人中心静脉导管相关血液感染病原菌分析[J].中国感染与化疗杂志,2017,17(6):629-632.
[6]张艳君,马秀珍,秦琴,等.血液感染病原菌的分布与耐药性分析[J].中国感染与化疗杂志,2017,17(3):314-320.
[7]李元,朱曦,江智霞,等.白血病病人PICC相关性血液感染目标性监测及危险因素分析[J].中华医院感染学杂志,2017,27(20):4622-4625.
[8]苟茹萍,赵兰菊,徐翠莲.重症病人发生血液感染的相关危险因素及对策[J].吉林医学,2017,38(8):1561-1562.
[9] Olaechea PM, Palomr M, lvarez-Lerma F, et al. Morbidiity and mortality associated with primary and catheter-related bloodstream infedtions in critically ill patients[J]. Rev Esp Quimioter, 2013, 26(1):21-29.
[10]汪彦,朱伦刚,蒋忠洋,等.血清降钙素原水平和APACHEⅡ评分动态变化对血液感染病人预后评估价值的分析[J].检验医学与临床,2016,13(9):1243-1245.
[11] Tao F, Jiang R, Chen Y, et al. Risk factors for early onset of catheter-related blood stream in fection in an intensive care unit in China:a retrospective study[J]. Med Sci Monit,2015, 21:550-556.
[12]赵凤容,陆水英,张秀渝,等.多重耐药鲍曼不动杆菌感染危险因素分析[J].检验医学与临床,2014,(10):1310-1312.
[13] Bloos F, Reinhart K. Rapid diagnosis of sepsis[J]. Virulence, 2014, 5(1):154-160.
[14]冯雪琴,吴润洁,卢兰芬,等.降钙素原、超敏C反应蛋白、白细胞介素6、白细胞联合检测在2型糖尿病血液感染诊断中的应用[J].国际检验医学杂志,2018,39(2):169-175.
[15]姚淑雯,王淑香,叶家骏,等.降钙素原、白细胞、中性粒细胞比率、C反应蛋白及血小板在早期成人细菌性脓毒症中的应用比较[J].广东医学,2017,38(A1):133-134,137.