急诊病区血行感染患者的死亡危险因素分析  

Prognostic determinants of death of patients with bloodstream infections in emergency department

作　　者：李楠[1] 白传哲[1] 王静[1] 高燕[1] 

机构地区：[1]沈阳军区总医院急诊科全军重症(战)创伤救治中心,辽宁沈阳110016

出　　处：《中华医院感染学杂志》2013年第7期1535-1537,共3页Chinese Journal of Nosocomiology

基　　金：辽宁省自然科学基金(20082069)

摘　　要：目的对急诊病区血行感染(BSI)患者的流行病学资料进行调查,探讨BSI患者死亡的危险因素。方法对2009年1月-2010年12月沈阳军区总医院急诊科病区BSI患者进行回顾性调查,按照其病情转归将其分为生存组和死亡组,筛选BSI患者死亡危险因素。结果 52例患者被确诊为BSI,发生率为2.9%,28d死亡率为30.8%;革兰阴性菌检出最高,占51.9%,BSI致患者的死亡率为56.3%;诊断BSI后的APACHEⅡ评分、器官功能障碍的数目、肾功能不全和凝血功能障碍均为BSI患者死亡的独立危险因素;及时正确使用抗菌药物可显著提高BSI患者生存率(P=0.038)。结论确诊BSI时的APACHEⅡ评分、器官功能障碍的数目、肾功不全和凝血功能障碍可以预测BSI患者病情的转归,及时正确使用抗菌药物是病情转归的关键因素。OBJECTIVE To investigate the epidemiological data of the patients with bloodstream infections （BSI） in emergency department and explore the risk factors associated with the death of the BSI patients. METHODS A retrospective study was performed to analyze the epidemic data of BSI in ED of General Hospital of Shenyang Military Region from Jan 2009 to Dec 2010. The patients were divided into the survival group and the death group according to the clinical outcomes, and the risk factors of the death of the BSI patients were screened. RESULTS Totally 52 cases were diagnosed as hospital-acquired ESI with the incidence rate of 2.9 %, and the 28-day mortality was 30.8%. The gram-negative bacteria were the most frequently isolated pathogens, accounting for 51.9%, an the mortality of the patients with BSI caused the pathogens was 56.3%. The APACHE Ⅱ score, the number of involving organs of dysfunctions, renal dysfunction, and coagulation disorders at onset of the BSI were the independent predictors of mortality. Appropriate use of antimicrobial agents could significantly improve the survival rate of the BSI patients（P〈 0. 038）. CONCLUSION The outcomes of the BSI patients can be predicted through observation of the APACHE Ⅱ score, the number of involving organs of dysfunctions, renal dysfunction, and coagulation disorders at onset of BSI. The appropriate use of antimicrobial agents is an important determina- tive factor for the clinical outcome.

关 键 词：血行感染 流行病学 器官功能障碍 危险因素 抗菌药物 治疗 

分 类 号：R181.32[医药卫生—流行病学]