神经重症合并肺部感染患者的病原体及死亡影响因素分析  

Analysis of pathogenic bacteria and influencing factors of death in patients with severe neurological pulmonary infection

作　　者：李春辉[1] 毛修月 朱骁 陈涛[1] 李欢 龚金兵 罗刚[1] 喻坚柏[1] 李利博 Li Chunhui;Mao Xiuyue;Zhu Xiao;Chen Tao;Li Huan;Gong Jinbing;Luo Gang;Yu Jianbai;Li Libo(Department of Neurosurgery,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院神经外科,长沙410007

出　　处：《中国医师杂志》2022年第6期859-862,870,共5页Journal of Chinese Physician

基　　金：湖南省科技创新计划项目(2018JJ3404);湖南省卫生健康委科研课题(20201190);中医药传承与创新"百千万"人才工程西学中骨干人才(08-01-04)。

摘　　要：目的探讨神经外科重症监护室(NICU)肺部感染患者的呼吸道病原体分布情况及死亡的影响因素。方法回顾性收集2018年1月至2019年12月入住湖南中医药大第一附属医院神经外科神经重症病房、合并有肺部感染的患者87例,通过对其呼吸道病原学分析,了解肺部感染的细菌种类及分布。采用单因素分析患者临床转归与年龄、糖尿病、高血压病、肾功能不全、低蛋白血症、贫血、慢性呼吸道疾病、手术、气管切开、细菌多重耐药的关系,二元logistic回归分析影响神经重症合并肺部感染患者死亡的影响因素。结果本研究组共分离致病菌112株,其中革兰阴性菌83株(74.11%),革兰阳性菌22株(19.64%),真菌7株(6.25%)。亚胺培南对革兰阴性菌敏感性高,万古霉素对革兰阳性菌敏感性较高,其他药物均耐药严重。患者死亡41例(47.13%),年龄≥60岁(OR=3.501,95%CI:1.152~10.638)、肾功能不全(OR=3.872,95%CI:1.336~11.224)、气管切开(OR=0.317,95%CI:0.114~0.882)、细菌多重耐药(OR=3.480,95%CI:1.162~10.422)是NICU肺部感染患者死亡的独立危险因素。结论神经重症患者病情危重,同时合并肺部感染患者多,革兰阴性菌为最多见的呼吸道病原体,患者预后差,死亡率高,临床中抗生素以碳青霉烯类使用占比最高。高龄、肾功能不全、细菌多重耐药增加患者的死亡率,而早期气管切开能降低患者的病死率。Objective To investigate the distribution of respiratory pathogens and risk factors of death in patients with pulmonary infection in neurosurgical intensive care unit(NICU).Methods A total of 87 patients with pulmonary infection in the NICU of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2018 to December 2019 were collected,and the pathogens of their respiratory tract were analyzed to understand the types and distribution of bacteria in the lung infection.Univariate statistical analysis was used to analyze the relationship between the patient's clinical outcome with age,diabetes,hypertension,renal insufficiency,hypoproteinemia,anemia,chronic respiratory disease,surgery,tracheotomy,and bacterial multi-resistance.Binary logistic regression analysis was used to analyze the influencing factors of death in NICU patients with pulmonary infection.Results A total of 112 pathogenic bacteria were isolated in this research group,including 83 Gram-negative bacteria(74.11%),22 Gram-positive bacteria(19.64%),and 7 Fungi(5.25%).Imipenem was highly sensitive to Gram-negative bacteria,vancomycin was highly sensitive to Gram-positive bacteria,and other drugs were highly resistant.41 patients died(47.13%).Age≥60(OR=3.501,95%CI:1.152-10.638),renal insufficiency(OR=3.872,95%CI:1.336-11.224),tracheotomy(OR=0.317,95%CI:0.114-0.882),bacteria multi-drug resistance(OR=3.480,95%CI:1.162-10.422)were independent risk factors for death in NICU patients with pulmonary infection.Conclusions Patients with severe neurological diseases are in critical condition,and there are many patients with pulmonary infection,with poor prognosis and high mortality.Gram-negative bacteria are the most common respiratory pathogens.Carbapenems account for the highest proportion of antibiotics in clinic.Advanced age,renal insufficiency and bacterial multidrug resistance increase the mortality of patients,while early tracheotomy can reduce the mortality of patients.

关 键 词：危险因素 重症监护病房 神经外科 肺部感染 微生物敏感性试验 

分 类 号：R563.1[医药卫生—呼吸系统] R651.1[医药卫生—内科学]