中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
8期
471-474
,共4页
乔莉%张劲松%梅亚宁%张华忠%苏成磊
喬莉%張勁鬆%梅亞寧%張華忠%囌成磊
교리%장경송%매아저%장화충%소성뢰
鲍曼不动杆菌%血流感染%危险因素%急性生理学与慢性健康状况评分系统Ⅱ评分
鮑曼不動桿菌%血流感染%危險因素%急性生理學與慢性健康狀況評分繫統Ⅱ評分
포만불동간균%혈류감염%위험인소%급성생이학여만성건강상황평분계통Ⅱ평분
Acinetobacter baumannii%Bloodstream infection%Risk factor%Acute physiology and chronic health evaluation Ⅱ
目的 探讨影响鲍曼不动杆菌血流感染预后的危险因素.方法 回顾性分析2010年1月至2012年1 1月南京医科大学第一附属医院住院的78例鲍曼不动杆菌血流感染患者的病例资料.根据28 d预后分为死亡组(40例)和存活组(38例),收集人口学资料、入住单元、基础疾病、治疗、有创操作、细菌耐药性和入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分；通过多因素logistic回归分析确定独立危险因素,采用受试者工作特征曲线(ROC曲线)下面积比较预测价值.结果 入住ICU[优势比(OR)=12.9,95％可信区间(95％CI)为2.4 ～ 63.5,P=0.001]、气道开放(包括气管插管和气管切开,OR=6.2,95％CI为1.5 ～30.4,P=0.023)、有创机械通气(OR=5.1,95％CI为1.4 ～ 22.6,P=0.042)、除深静脉置管的其他有创操作(包括胸腔穿刺、骨髓穿刺、腰椎穿刺、留置尿管、纤维支气管镜肺泡灌洗、动静脉内瘘成形术,OR=8.4,95％CI为1.7～37.8,P=0.011)、入院时APACHEⅡ≥19分(OR=35.4,95％CI为3.8 ～ 318.6,P=0.001)是鲍曼不动杆菌血流感染患者死亡的危险因素.以APACHEⅡ≥19分为分界点,ROC曲线下面积为0.938(P＜0.05),敏感度为76.2％,特异度为94.1％.细菌的耐药性对预后无明显影响.结论 侵入性操作及治疗会增加危重症鲍曼不动杆菌血流感染患者的病死率；APACHEⅡ≥19分提示鲍曼不动杆菌血流感染预后差.
目的 探討影響鮑曼不動桿菌血流感染預後的危險因素.方法 迴顧性分析2010年1月至2012年1 1月南京醫科大學第一附屬醫院住院的78例鮑曼不動桿菌血流感染患者的病例資料.根據28 d預後分為死亡組(40例)和存活組(38例),收集人口學資料、入住單元、基礎疾病、治療、有創操作、細菌耐藥性和入院時急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分；通過多因素logistic迴歸分析確定獨立危險因素,採用受試者工作特徵麯線(ROC麯線)下麵積比較預測價值.結果 入住ICU[優勢比(OR)=12.9,95％可信區間(95％CI)為2.4 ～ 63.5,P=0.001]、氣道開放(包括氣管插管和氣管切開,OR=6.2,95％CI為1.5 ～30.4,P=0.023)、有創機械通氣(OR=5.1,95％CI為1.4 ～ 22.6,P=0.042)、除深靜脈置管的其他有創操作(包括胸腔穿刺、骨髓穿刺、腰椎穿刺、留置尿管、纖維支氣管鏡肺泡灌洗、動靜脈內瘺成形術,OR=8.4,95％CI為1.7～37.8,P=0.011)、入院時APACHEⅡ≥19分(OR=35.4,95％CI為3.8 ～ 318.6,P=0.001)是鮑曼不動桿菌血流感染患者死亡的危險因素.以APACHEⅡ≥19分為分界點,ROC麯線下麵積為0.938(P＜0.05),敏感度為76.2％,特異度為94.1％.細菌的耐藥性對預後無明顯影響.結論 侵入性操作及治療會增加危重癥鮑曼不動桿菌血流感染患者的病死率；APACHEⅡ≥19分提示鮑曼不動桿菌血流感染預後差.
목적 탐토영향포만불동간균혈류감염예후적위험인소.방법 회고성분석2010년1월지2012년1 1월남경의과대학제일부속의원주원적78례포만불동간균혈류감염환자적병례자료.근거28 d예후분위사망조(40례)화존활조(38례),수집인구학자료、입주단원、기출질병、치료、유창조작、세균내약성화입원시급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분；통과다인소logistic회귀분석학정독립위험인소,채용수시자공작특정곡선(ROC곡선)하면적비교예측개치.결과 입주ICU[우세비(OR)=12.9,95％가신구간(95％CI)위2.4 ～ 63.5,P=0.001]、기도개방(포괄기관삽관화기관절개,OR=6.2,95％CI위1.5 ～30.4,P=0.023)、유창궤계통기(OR=5.1,95％CI위1.4 ～ 22.6,P=0.042)、제심정맥치관적기타유창조작(포괄흉강천자、골수천자、요추천자、류치뇨관、섬유지기관경폐포관세、동정맥내루성형술,OR=8.4,95％CI위1.7～37.8,P=0.011)、입원시APACHEⅡ≥19분(OR=35.4,95％CI위3.8 ～ 318.6,P=0.001)시포만불동간균혈류감염환자사망적위험인소.이APACHEⅡ≥19분위분계점,ROC곡선하면적위0.938(P＜0.05),민감도위76.2％,특이도위94.1％.세균적내약성대예후무명현영향.결론 침입성조작급치료회증가위중증포만불동간균혈류감염환자적병사솔；APACHEⅡ≥19분제시포만불동간균혈류감염예후차.
Objective To explore the risk factors on prognosis of Acinetobacter baumannii bloodstream infection.Methods Clinical data from 78 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Nanjing Medical University from January 2010 to November 2012 were analyzed retrospectively.According to the 28-day prognosis after admission,the patients were divided into non-survivors (n=40) and survivors (n=38).Data on demographic and clinical characteristics,wards,underlying diseases,treatments,invasive medical procedures,bacterial resistance to antibiotics,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in the beginning were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.The predictor value was concluded by comparing area under the receiver operating characteristic curve (ROC curve) of each index.Results Risk factors of mortality of Acinetobacter baumannii bloodstream infection goes as following,including intensive care unit admission [ICU,odds ratio (OR)=12.9,95％ confidence interval (95％ CI) 2.4-63.5,P=0.001],trachea intubationor tracheostomy (OR =6.2,95％ CI 1.5-30.4,P=0.023),invasive mechanical ventilation (OR =5.1,95％ CI 1.4-22.6,P=0.042),invasive medical procedure besides central venous catheter (including thoracentesis,bone marrow puncture,lumbar puncture,catheterization,bronchoalveolar lavage with bronchofibroscope,arteriovenous fistula plastic operation,OR =8.4,95％CI 1.7-37.8,P=0.011),APACHE Ⅱ score ≥ 19 in the beginning (OR=35.4,95％CI 3.8-318.6,P=0.001).With respect to APACHE Ⅱ score ≥ 19 as mortality cut-off point,an area under the receiver operating curve of 0.938 was statistically significant (P＜0.05),with sensitivity 76.2％ and specificity 94.1％.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusion Invasive medical procedures and treatments were associated with increased mortality of patients with Acinetobacter baumannii bloodstream infection.A strong predictor of adverse outcome in such conditions was APACHE Ⅱ score ≥ 19.
