经重症监护的供者发生血行感染的高危因素分析  

High risk factors of blood infection in voluntary donors in China： A single-centre retrospective study

作　　者：童荔[1] 郑东华[2] 朱艳平[1] 胡晓光[1] 蔡常洁[1] 

机构地区：[1]中山大学附属第一医院(本部)重症医学科,广州510080 [2]中山大学附属第一医院(东院)重症医学科

出　　处：《中华器官移植杂志》2016年第12期753-757,共5页Chinese Journal of Organ Transplantation

基　　金：广东省科技计划基金（201313060300006）

摘　　要：目的分析和归纳经重症监护的供者发生血行感染的高危因素。方法纳入2014年10月至2016年1月重症医学科的器官捐献供者70例。采用单因素分析及多因素logistic回归分析，找出经重症监护的供者血行感染的高危因素。并建立供者血行感染评估模型以及受试者工作特征曲线（ROC曲线），评估其灵敏度以及特异度。结果经重症监护的供者感染发生率为64.3%（45/70）。其中，肺部感染为42.9%，血行感染31.4%，尿路感染1.4%。以供者发生血行感染为因变量，行单因素统计学分析提示，总住院时间（〉10 d，P＝0.017）、氧合指数（〈233.5±107.0，P＝0.046）、天冬氨酸转氨酶（AST）（〉196.9±329.1 U/L，P＝0.044）、丙氨酸转氨酶（ALT）（〉95.0±78.1 U/L，P＝0.026）是供者血行感染的高危因素。多因素logistic回归分析发现，其中总住院时间〉10 d以及氧合指数（〈233.5±107.0）是供者发生血行感染的独立高危因素。以此建立评估供者血行感染的模型为：0.193＋1.753×住院天数（〉10 d）－0.007×氧合指数，敏感度和特异度分别为0.682和0.75（P〈0.001）。结论在重症监护时间长的供者血行感染的发生率较高，应选择较强抗感染方案；通过改善供者氧合指数和肝功能，可以减少感染的发生率，从而提高器官捐献的成功率。ObjectiveTo analyze the high risk factors of blood infection in Chinese citizens’ organ donation, provide the basic evidence for early protection, increase the success rate of donor distribution, and expand the Chinese organ donation pool. MethodsA retrospective study was performed on 70 cases of donation recruited during October 2014 to January 2016. The incidence of blood infection in these donors was analyzed. The univariate analysis and multivariate logistic regression analysis were used to find out the high risk factors influencing the donor blood infection. Finally, the donor blood infection assessment model and the receiver operating characteristic （ROC） curve were established to assess the sensitivity and specificity. ResultsThe overall infection rate was 64.3% （45/70）. The pulmonary, blood, and urinary tract infection rate was 42.9%, 31.4% and 1.4% respectively. The total length of hospital stay （〉10 days） （P=0.017）, oxygenation index （〈233.5±107.0） （P=0.046）, aspartate aminotransferase （〉196.9±329.1 U/L） （P=0.044）, and valley alanine aminotransferase （〉95.0±78.1 U/L） （P=0.026） were four risk factors for predicting the donor blood infection. The multivariate logistic regression analysis revealed that the total length of stay 〉10 days along with the donors＇ oxygenation index （〈233.5±107.0） was independent risk factor for predicting the blood infection. The donor blood infection model was： 0.193＋ 1.753 hospital stay （〉10 days） -0.007 oxygenation index. The sensitivity and specificity were 0.682 and 0.75 （P〈0.001） respectively. ConclusionFor a long-term stay in ICU, the rate of blood infection for donors was much higher, at this time, the most effective antibiotics should be chosen. Besides, improving donor oxygenation index and liver function can reduce the incidence of infection.

关 键 词：器官捐献 肝移植 血行感染 

分 类 号：R45[医药卫生—治疗学]