特重度烧伤合并吸入性损伤患者血流感染的临床特征及其主要风险因素分析  

Analysis of clinical characteristics and main risk factors of bloodstream infection in patients with severe burn combined with inhalation injury

作　　者：马珍珠 窦懿[2] 张寅[2] 张勤[2] 吴蓓雯[3] Ma Zhenzhu;Dou Yi;Zhang Yin;Zhang Qin;Wu Beiwen(School of Nursing,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Burns and Plastic Surgery,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Nursing,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学护理学院,200025 [2]上海交通大学医学院附属瑞金医院灼伤整形科,200025 [3]上海交通大学医学院附属瑞金医院护理部,200025

出　　处：《中华损伤与修复杂志（电子版）》2021年第5期406-410,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的通过研究特重度烧伤合并吸入性损伤患者临床特征和风险因素,为未来构建特重度烧伤合并吸入性损伤患者血流感染风险模型提供依据。方法回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2010年1月1日至2019年12月31日收治的符合入选标准的185例患者的病历资料。分析其基本特征、烧伤情况、转运情况、血流感染的特点、治疗及结局。根据其是否发生血流感染将患者分为感染组62例(33.51%)和未感染组123例(66.49%),分析该类患者血流感染的临床特征及发生血流感染的危险因素,并行单因素分析和Logistic回归分析。结果185例特重度烧伤合并吸入性损伤患者中有62例发生血流感染。检出阳性率从高到低的前3位细菌分别是肺炎克雷伯菌(36.25%),铜绿假单胞菌(28.75%),鲍曼不动杆菌(13.75%)。感染组烧伤总面积、Ⅲ度烧伤面积均显著高于非感染组,差异均有统计学意义(Z=4.361、4.652,P<0.05);感染组ICU住院时间、住院时间显著长于非感染组,差异均有统计学意义(Z=4.297、2.769,P<0.05)。感染组和非感染组男女构成比差异有统计学意义(χ^(2)=4.237,P<0.05)。感染组和非感染组接受机械通气的患者构成比差异有统计学意义(χ^(2)=13.788,P<0.05)。最终Logistic回归结果显示ICU住院时间为独立危险因素(OR=1.035,95%CI=1.014~1.057,P<0.05)。结论特重度烧伤合并吸入性损伤患者具有血流感染高风险,其中肺炎克雷伯杆菌、铜绿假单胞菌、鲍曼不动杆菌等革兰氏阴性菌为主要致病菌,ICU住院时间为特重度烧伤合并吸入性损伤患者发生血流感染的独立危险因素。Objective To investigate the clinical characteristics and risk factors of bloodstream infection and to provide basis for constructing the risk model of bloodstream infection in patients with severe burn combined with inhalation injury in the future.Methods Clinical data of 185 patients who met the inclusion criteria in Department of Burns and Plastic Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 1,2010 to December 31,2019 were retrospectively analyzed.Demographic characteristics,burn condition,transfer condition,characteristics of bloodstream infection and prognosis,treatment and outcome were analyzed.The patients were divided into infected group(n=62,33.51%)and uninfected group(n=123,66.49%)according to whether or not they had bloodstream infection.The characteristics of bloodstream infection and the risk factors of bloodstream infection in these patients were analyzed through Mann-Whitney U test、χ^(2) test and Logistic regression analysis.Results Sixty-two of the 185 patients with severe burn combined with inhalation injury had bloodstream infection.The top three bacteria with positive rate from high to low were Klebsiella pneumoniae(36.25%),Pseudomonas aeruginosa(28.75%)and Acinetobacter baumannii(13.75%).Compared with non-infection group,the total burn area,full-thickness burn area,ICU length of stay and length of hospital stay of infection group were obviously higher than the non-infection group,the differences were statistically significant(Z=4.361,4.652,4.297,2.769;P<0.05).The constituent ratio of male and receiving mechanical ventilation were higher in infection group,the differences were statistically significant(χ^(2)=4.237,13.788;P<0.05).Further logistic regression analysis showed that ICU length of stay was the independent risk factor for the severe burn patients combined with inhalation injury(odds ratio=1.035,95%confidence interval=1.014-1.057,P<0.05).Conclusion The incidence of bloodstream infection was high in patients with severe burn combined with inha

关 键 词：烧伤 损伤 吸入性 危险因素 血流感染 

分 类 号：R644[医药卫生—外科学]