心脏术后体外膜肺氧合支持治疗的医院感染分析  

Nosocomial infection in postcardiotomy patients with extracorporeal membrane oxygenation support

作　　者：闫晓蕾[1] 李群 杨勇[1] 万久贺[1] 贾明[1] 侯晓彤[3] 孟旭[4] 贾士杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院监护室,北京100029 [2]清华大学第一附属医院心内科,北京100016 [3]首都医科大学附属北京安贞医院体外循环室,北京100029 [4]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《中华医院感染学杂志》2011年第3期462-465,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析进行体外膜肺氧合(ECMO)支持治疗患者医院感染情况。方法回顾性收集、分析医院2005年8月-2009年8月应用ECMO辅助治疗患者的医院感染资料。结果 120例患者,平均年龄(51.6±13.9)岁,医院感染49例,感染率40.8%;分离病原菌146株,其中革兰阴性菌81株,占55.5%,革兰阳性菌51株,占34.9%,真菌14株,占9.6%;医院感染组患者死亡27例,病死率为55.1%,非医院感染组死亡26例,病死率为36.6%,两组患者病死率差异有统计学意义(P<0.05);logistic回归分析医院感染与二次气管插管以及ICU滞留时间有关。结论医院感染是ECMO支持治疗的常见并发症之一,并且二次气管插管以及ICU滞留时间是其独立危险因素,严格无菌操作,合理使用抗菌药物,以降低病死率。OBJECTIVE To analyze the nosocomial infection in patients with extracorporeal membrane oxygenation（ECMO） support after cardiac surgery.METHODS The clinical data of patients who underwent cardiac surgery with application of ECMO from Aug 2005 to Aug 2009 were retrospectively collected and analyzed.RESULTS The average age was 51.6±13.9 years.82 patients（68.3%） were male.Incidence of nosocomial infection was 40.8% in all 120 cases.A total of 149 strains were isolated in which Gram-negative bacteria accounted for 55.5%,Gram-positive bacteria for 34.9% and fungi for 9.6%.Among them,the most common infection site was respiratory tract infection（56.3%）.The hospital mortality was much higher among patients with nosocomial infection than in patients without nosocomial infection（55.1% vs 36.6%,P0.05）.The nosocomial infection was related with re-intubation and length of ICU stay according to the logistic regression analysis.CONCLUSION The nosocomial infection is one of common complications in postcardiotomy patients with ECMO and the independent risk factors of postoperative nosocomial infection are re-intubation and length of ICU stay.The strict aseptic technique and rational application of antibiotics can reduce the mortality.

关 键 词：医院感染 心脏手术 体外膜肺氧合 

分 类 号：R181.32[医药卫生—流行病学]