基于病原学调查的急诊ICU初始抗感染策略的应用研究  

Application of initial anti-infection strategy in emergency ICU based on etiological investigation

作　　者：陈毓[1] 吴德军[1] 马爽 CHEN Yu;WU De-jun;MA Shuang(Emergency Department,Quzhou People's Hospital,Quzhou,Zhejiang 324000,China)

机构地区：[1]衢州市人民医院急诊科,浙江衢州324000

出　　处：《中国卫生检验杂志》2020年第15期1875-1878,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的探讨病原导向初始抗感染策略在急诊ICU抗感染中的应用价值。方法回顾性分析337例中重度感染患者资料,其中2016年1月-2017年4月166例(对照组),采用经验性初始抗感染策略,2017年5月-2019年1月171例(研究组)采用病原导向初始抗感染策略。对比2组的治愈率、死亡率、住院时间、抗菌药物使用频度(DDDs)及住院费用;统计患者治疗前后不同时间点的血清标志物水平和重症评分量表。结果与对照组相比,研究组DDDs和死亡率降低,住院费用减少,差异有统计学意义(P<0.05)。治疗72 h,研究组血清乳酸、肌酐、CRP和PCT水平低于对照组(P<0.05);出院时,研究组APACHEⅡ评分低于对照组(P<0.05)。2016年-2018年,急诊ICU的病原菌分布大体一致,均以革兰阴性菌为主,3年占比分别为58.2%、62.9%和56.4%;其次是革兰阳性菌,3年占比分别为34.0%、29.1%和36.9%。结论病原导向初始抗感染策略有利于提高急诊ICU抗感染效果,降低死亡率。Objective To explore the clinical application value of initial anti-infection strategy in emergency ICU based on etiological investigation.Methods The data of 337 patients admitted in the emergency ICU of Quzhou People's Hospital was analyzed retrospectively.There were 166 cases from January 2016 to April 2017(the control group,treated with empirical initial anti-infection strategy)and 171 case from May 2017 to January 2019(the study group,treated with etiology initial anti-infection strategy).The cure rate,mortality,hospital stay length,frequency of antibacterial drug use(DDDs)and hospitalization cost were compared between the two groups.The serum biochemical markers and critical scale score were compared too.Meanwhile,the change of pathogen was analyzed to guide the improvement of initial anti-infection strategy.Results Compared with the control group,DDDs and mortality decreased in the study group,and hospitalization expenses reduced,with the differences statistically significant(P<0.05).After 72 h treatment,the team lactic acid,serum creatinine,CRP and PCT levels of the study group were lower than the control group(P<0.05);and on discharge,the APACHEⅡscore of the study group was lower than the control group,the differences were statistically significant(P<0.05).From 2016 to 2018,the distribution of pathogenic bacteria in the emergency ICU was generally consistent,with gram-negative bacteria as the main pathogen,accounting for 58.2%,62.9%and 56.4%,followed by gram-positive bacteria,accounting for 34.0%,29.1%and 36.9%.Conclusion Pathogene-guided initial anti-infection strategy is beneficial for improving anti-infection effect of emergency ICU and reducing mortality.

关 键 词：病原学 初始抗感染 急诊 重症监护室 

分 类 号：R446.5[医药卫生—诊断学]