机构地区:[1]中南大学湘雅医院呼吸与危重症医学科,长沙410008 [2]中南大学湘雅三医院呼吸与危重症医学科,长沙410013 [3]长沙市第一医院ICU,410005 [4]长沙市第四医院ICU,410006 [5]株洲市第一医院ICU,412000 [6]岳阳市第二人民医院呼吸与危重症医学科,414000
出 处:《国际呼吸杂志》2015年第19期1460-1464,共5页International Journal of Respiration
基 金:湖南省社会发展支撑项目(2013SK3027)
摘 要:目的探讨湖南省ICU医院获得性鲍曼不动杆菌肺炎(Acinetobacter baumannii hospitalacquired pneumonia,ABHAP)的预后危险因素。方法以湖南省6家医院ICU在2010年12月至2011年12月期间发生的116例ABHAP患者为研究对象,收集患者的临床资料并记录住院28d内病死率,按住院28d内患者死亡情况,将ABHAP患者分为生存组和死亡组,采用单因素分析(t检验和x^2检验)和非条件Logistic多元回归分析方法对患者的死亡危险因素进行分析。结果116例ABHAP患者中,死亡54例,ABHAP患者28d病死率为46.6%。单因素分析发现,APACHEⅡ评分(t=2.399,P=.018)、降钙素原水平(t=2.513,P=0.013)、慢性肺部疾病(x^2=4.629,P=0.031)、合并真菌感染(x^2=5.321,P=0.021)、低蛋白血症(x^2=4.701,P=0.030)、休克(x^2=6.037,P=0.014)、气管插管(x^2=5.304,P=0.021)、支气管镜吸痰(x^2=8.295,P=0.004)以及有创通气〉7d(x^2=5.316,P=0.021)与ABHAP死亡有关。Logistic多元回归分析发现,低蛋白血症(OR=3.583,95%CI:1.321~9.718,P=0.012)、休克(OR=5.261,95%CI:1.209~22.885,P=0.027)和支气管镜吸痰(OR=3.304,95%CI:1.029~10.614,P=0.045)为ABHAP死亡的独立危险因素。结论低蛋白血症、病程中出现休克和支气管镜吸痰为ABHAP死亡的独立危险因素,应针对危险因素采取措施进行控制。Objective To identify the risk factors for mortality of the patients with Acinetobacter baumannii hospital-acquired pneumonia (ABHAP) in intensive care unit (ICU) in Hunan province. Methods 116 patients with ABHAP who were admitted in ICU from December 2010 to December 2011 in six hospitals in Hunan province were selected as the subjects of the study, who were divided into two groups (survival/death) based on the prognosis within 28 days. The clinical data and 28-day mortality of patients with ABHAP were measured. The risk factors for mortality of the patients with ABHAP were analyzed by using univariate analysis ( t test or x^2 test) and multivariate Logistic regression analysis. Results Among the 116 patients with ABHAP, 54 patients died, the 28-day mortality was 46.6%. Univariate analysis revealed that nine factors were associated with the mortality of ABHAP, including APACHE Ⅱ score ( t = 2. 399, P = 0. 018), procalcitonin ( t = 2. 513, P = 0. 013) ,chronic respiratory disease ( x^2 = 4. 629, P = 0. 031 ), fungal infections ( x^2 = 5. 321, P = 0. 021 ), hypoalbuminemia ( x^2 = 4. 701, P =0. 030),shock in the course of disease ( x^2 =6. 037, P =0. 014),tracheal intubation ( x^2=5. 304, P = 0.021), bronchial lavage ( x^2 = 8. 295, P = 0. 004), and invasive positive pressure ventilation〉7 days '( x^2= 5. 316, P = 0. 021). Multivariate Logistic regression analysis indicated that hypoalbuminemia (OR = 3. 583,95% CI :1. 321-9. 718, P =0. 012) ,shock in the course of disease ( OR = 5. 261,95% CI : 1. 209-22. 885, P =0.027),and bronchial lavage (OR =3.304,95%CI :1.029-10.614, P =0.045) were the independent risk factors for ;mortality of the patients with ABHAP. Conclusions The independent risk factors for mortality of the patients with ABHAP are hypoalbuminemia, shock in the course of disease,and bronchial lavage. Measures aiming at the risk factors should be taken to control the mortality of ABHAP.
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