体外膜肺氧合中继发血行感染并发症与防控措施  

Nosocomial bloodstream infections in patients undergoing extracorporeal membrane oxygenation:clinical report and review of preventive procedures

作　　者：李欣[1] 杨敏[2] 张海[2] 李赛琪[2] 吴乾[2] 郭震 徐凌峰[1] 常昕[1] 

机构地区：[1]上海市胸科医院体外循环室,上海200030 [2]上海市胸科医院重症监护室,上海200030

出　　处：《中国体外循环杂志》2010年第1期16-20,共5页Chinese Journal of Extracorporeal Circulation

基　　金：上海市科委引导计划科研基金(09411961000)

摘　　要：目的回顾分析上海市胸科医院体外膜肺氧合(ECMO)病例血培养阳性报告和患者转归,对其心肺支持中继发血行感染的后果与防控措施等进行文献复习。方法从2007年1月到2009年12月,共对21例处于严重但可逆心肺功能衰竭患者进行ECMO呼吸/循环支持。该病例组排除病因为感染性休克需要ECMO支持患者。在ECMO开始24h后到ECMO结束48h内每日进行血培养。记录患者ECMO常规数据以及感染相关临床症状和实验室检查结果。结果21例患者中发现血培养阳性3例。2例静脉-动脉(V-A)ECMO支持虽心功能恢复,成功撤离ECMO,但均因感染等造成多脏器功能衰竭死亡;1例静脉-静脉(V-V)ECMO支持,肺功能恢复良好,撤离ECMO并出院。培养阳性菌主要为G-杆菌(鲍曼氏不动杆菌和铜绿假单孢菌)和G+球菌(头状葡萄球菌)。培养出鲍曼氏不同杆菌显示多重耐药。结论ECMO支持过程中继发血行感染严重影响患者生存机会。造成感染菌群与国内、国际重症监护病房常见菌种相同。影响ECMO支持感染并发症的风险因素主要是ECMO支持持续时间。严格感染防控措施有助于降低血行感染并发症的发生。更注重细节管理和多中心数据库的建立是我国ECMO技术未来发展方向。OBJECTIVE This study aimed to investigate the incidence and outcome for nosocomial bloodstream infection in patients receiving extracorporeal membrane oxygenation（ECMO） from 2007 to 2009. Reviewed international research and experience in epidemiology and preventive procedures for nosocomial bloodstream infection. METHODS From Jan 2007 to Dec 2009, 21 eases with severe but possible recoverable heart or lung failure underwent ECMO support. ECMO support for septic shock was excluded. ECMO - related nosocomial infections were defined as infections occurring from 24 h after ECMO initiation until 48 h after ECMO discontinuation, All ECMO patients had blood culture daily as routine procedure. RESULTS 3 cases with positive blood culture were detected. 1 patient with V - V ECMO survived to discharge and 2 patients with V - A ECMO died from muhiorgan failure though both successfully weaned off from ECMO support. Gram negative bacilli were responsible for all of the nosocomial bloodstream infections in these 3 cases. CONCLUSION Nosocomial bloodstream infection is the one of the most risky complications for patients in ECMO support. The most common causative pathogens of bloodstream infection during ECMO support were same with reports by chinese and international research. Detailing ECMO management and central database will be very helpful for the development of ECMO practice in China.

关 键 词：体外膜肺氧合 感染 转归 防控措施 

分 类 号：R654.1[医药卫生—外科学]