不同免疫功能状态血流感染患者临床特点及死亡危险因素分析  

作　　者：沈国忠 李英 沈建英 陈胜兰 

机构地区：[1]浙江省绍兴市中心医院,312030

出　　处：《浙江临床医学》2019年第10期1392-1394,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨不同免疫功能状态下的血流感染患者的临床特点,分析因血流感染死亡的危险因素.方法回顾性分析2016年4月至2017年4月间在本院住院期间确诊的医院获得性血流感染患者共140例,根据免疫功能状态不同分为免疫功能抑制组(ICH)和免疫功能正常组(NICH),比较两组患者临床特征,同时对死亡患者进行危险因素分析.结果ICH组患者28d内病死率、复数菌感染率、低白蛋白血症比例均显著高于NICH组;而NICH组入ICU治疗的比例、CRP水平显著高于ICH组.两组患者间病原体构成、性别、年龄、白细胞计数、D-二聚体、PCT等均无显著性差异.单因素分析结果显示,免疫功能抑制、低白蛋白血症、感染性休克、中心静脉导管植入是BSI患者28d内死亡的危险因素,多因素logistic回归分析显示,免疫功能抑制、感染性休克、中心静脉导管植入是BSI患者死亡的独立危险因素.结论ICH血流感染预后不佳,应早期识别、干预感染性休克,减少中心静脉导管植入等危险因素,降低病死率.Objective To explore the clinical manifestations of bloodstream infection(BSI)patients with different immune status and risk factors of mortality.Methods Clinical data of 140 patients with bloodstream infection hospitalized in our hospital from April 2016 to April 2017 were analyzed retrospectively.The patients were divided into immunocompromised host(ICH)group and Non-immunocompromised host(N1CH)group.Risk factors were analyzed according to 28-day prognosis.Results In ICH group,the 28-day mortality,the rate of polymicrobial infection and the proportion of hypoalbuminemia were all significantly higher than those in NICH group.The proportion of NICH into ICU treatment and the level of CRP were significantly higher than those of the ICH group.There was no significant difference in pathogen composition,sex,age,white blood cell count,D-dimcr,and PCT between the two groups.Single factor analysis showed that immunosuppression,hypoalbuminemia,septic shock,and central venous catheter implantation were the risk factors for 28-day mortality of BSI patients.Multivariate logistic regression analysis showed that immunosuppression,septic shock,and central venous catheter implantation were independent risk factors for death of BSI patients.Conclusion ICH with BSI has a poor prognosis.It is necessary to identify and intervene with septic shock early,reduce risk factors such as central venous catheter implantation,and reduce the mortality rate.

关 键 词：血流感染 免疫功能抑制 危险因素 

分 类 号：R47[医药卫生—护理学]