术后MRSA肺炎的危险因素分析  

RISK FACTORS OF POSTOPERATIVE MRSA PNEUMONIA

作　　者：孙晓霞[1] 方巍[1] 孙运波[1] 

机构地区：[1]青岛大学医学院附属医院ICU,山东青岛266003

出　　处：《齐鲁医学杂志》2011年第3期235-237,239,共4页Medical Journal of Qilu

摘　　要：目的分析术后耐甲氧西林金黄色葡萄球菌(MRSA)肺炎相关危险因素,以制定有效的防护措施。方法回顾性收集2007年10月—2008年12月我院急症和择期手术后确诊为肺炎的406例病人的资料,用SPSS软件分析术后MRSA肺炎相关危险因素。结果确诊MRSA肺炎33例,检出率为8.12%,死亡8例,病死率24.2%。单因素相关分析筛选出术后MRSA肺炎发病的8项可能危险因素:年龄≥60岁、住院≥20 d、广谱抗生素使用>10 d、颅脑手术、气管插管或切开(未行机械通气)、机械通气、深静脉置管、抑酸剂的应用。多因素Logistic回归分析提示,住院≥20 d、广谱抗生素使用>10 d、颅脑手术、气管插管或切开是术后MRSA肺炎发病的独立危险因素。结论住院≥20 d、广谱抗生素使用>10 d、颅脑手术、气管插管或切开是术后MRSA肺炎发病的独立危险因素,需要综合预防才能降低其发病率。Objective To analyze risk factors that cause postoperative methicillin-resistant staphylococcus aureus（MRSA） pneumonia,and set up protective strategies. Methods Clinical data of 406 patients with postoperative pneumonia afteracute or selected surgery,between Oct.2007 and Dec.2008,were reviewed.Postoperative-MRSA-pneumonia-related risk factors were analyzed with SPSS software. Results Thirty-three patients developed postoperative MRSA pneumonia,the detection rate was 8.12%.Eight patients（24.2%） died.The eight possible risk factors of postoperative MRSA pneumonia,identified with univariate Pearson Chi-Square test,were age ≥60 years,hospital stay ≥20 d,broad-spectrum antibiotics usage（10 d）,brain surgery,endotracheal intubation or incision（without mechanical ventilation）,mechanical ventilation,intravenous catheter,and the application of acid suppression agents.Multivariable logistic regression analysis revealed that hospitalization ≥ 20 d,broad-spectrum antibiotics 10 d,brain surgery,endotracheal intubation or incision were independent risk factors of postoperative MRSA pneumonia. Conclusion Hospital stay ≥20 d,broad-spectrum antibiotics application 10 d,brain surgery,and endotracheal intubation or incision are independent risk factors of postoperative MRSA pneumonia.Only comprehensive prevention is carried out,can we reduce the morbidity of MRSA.

关 键 词：肺炎 葡萄球菌 金黄色 甲氧西林抗药性 手术后并发症 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统] R378.11[医药卫生—内科学]