CAJ | 학술논문

目的探讨导致创伤患者在重症监护病房期间发生院内感染的危险因素.方法回顾性分析了2009年1月1日至12月31日浙江省5家医院1103名创伤患者的相关资料,通过对16项可能和发生感染的相关因素的单因素以及多因素分析,最终筛选出导致所有创伤患者以及严重创伤患者住ICU期间发生感染的独立危险因素.结果住ICU期间共有171人(15.5%)发生感染.患者总共死亡157人(14.2%),其中感染组死亡59人.感染组病死率为34.7%,显著高于非感染组的10.5%.多因素logistic回归分析结果提示,对于所有患者而言,中心静脉压监测、机械通气、年龄≥65岁、住ICU时间>14 d以及ISS≥16分为住ICU期间发生院内感染的独立危险因素.对于严重创伤患者,中心静脉压监测、机械通气以及住ICU时间>14 d则是其独立危险因素.结论伤情严重程度、年龄、住ICU时间以及ICU内侵入性操作与创伤患者住ICU期间发生院内感染相关,规范各种侵入性操作以及尽量减少患者住ICU时间有助于降低患者发生院内感染的机率.
목적 탐토도치창상환자재중증감호병방기간발생원내감염적위험인소.방법 회고성분석료2009년1월1일지12월31일절강성5가의원1103명창상환자적상관자료,통과대16항가능화발생감염적상관인소적단인소이급다인소분석,최종사선출도치소유창상환자이급엄중창상환자주ICU기간발생감염적독립위험인소.결과 주ICU기간공유171인(15.5%)발생감염.환자총공사망157인(14.2%),기중감염조사망59인.감염조병사솔위34.7%,현저고우비감염조적10.5%.다인소logistic회귀분석결과제시,대우소유환자이언,중심정맥압감측、궤계통기、년령≥65세、주ICU시간>14 d이급ISS≥16분위주ICU기간발생원내감염적독립위험인소.대우엄중창상환자,중심정맥압감측、궤계통기이급주ICU시간>14 d칙시기독립위험인소.결론 상정엄중정도、년령、주ICU시간이급ICU내침입성조작여창상환자주ICU기간발생원내감염상관,규범각충침입성조작이급진량감소환자주ICU시간유조우강저환자발생원내감염적궤솔.
Objective To determine risk factors in nosocomial infection of trauma patients during intensive care unit stay. Methods A retrospective study was carried out. A total of 1103 trauma patients admitted to the intensive care unit of five tertiary hospitals in Zhejiang Province in 2009 were reviewed. Demographic data, injury severity score and other variables related to the trauma services were collected. Univariate and multivariate analysis were processed to identify the independent risk factors of nosocomial infection in trauma patients during stay in intensive care unit. Results Overall, 171 patients( 15.5% )developed nosocomial infection during ICU stay. Of 1103 patients, 157 patients (14.2% ) died, and the 59 fatal patients were from infection group. The mortality rate in infection group was 34.7% , which was significantly higher than that in non - infection group (10.5% ). The independent risk factors of nosocomial infection in all the patients determined by using multivariate analysis included central venous monitoring, mechanical ventilation, age ≥65, the length of ICU stay > 14 days and injury severity score ≥ 16. For the severe trauma patients, central venous monitoring, mechanical ventilation, the length of ICU stay > 14 days were independent risk factors of nonsocomial infection. Conclusions The severity of injury, age, the length of ICU stay and invasive procedures were related to the nosocomial infection. To standardize the invasive procedures and to reduce the length of ICU stay may decrease the infection rate of trauma patients.