机械通气患者质谱激光病原学检测气管导管末端病原菌的特征分析  

Clinical characteristics of pathogen of endotracheal tube end in patients with mechanical ventilation based on mass spectrometry and laser pathogen detection

作　　者：王莉[1] 汪婉婷 李武林 孙亚蒙 豆振锋 姜婷婷 徐军 吴晓 WANG Li;WANG Wanting;LI Wulin;SUN Yameng;DOU Zhenfeng;JIANG Tingting;XU Jun;WU Xiao(Department of Emergency,Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences,Shanghai 201800,China;Department of General Practice,Jiading Gongye District Community Healthcare Center of Jiading District,Shanghai 201800 China;Bochen Center Laboratory,Shanghai 200233,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院急诊科,上海201800 [2]上海市嘉定区嘉定工业区社区卫生服务中心全科医学科,上海201800 [3]上海柏辰中心实验室,上海200233

出　　处：《检验医学与临床》2022年第15期2068-2072,共5页Laboratory Medicine and Clinic

基　　金：上海市嘉定区科学技术委员会自然科学研究项目(JDKW-2020-0020)。

摘　　要：目的基质辅助激光解析电离飞行时间质谱检测,探讨机械通气患者气管导管末端病原菌的临床特征及相关影响因素。方法选取2019-2020年上海健康医学院附属嘉定区中心医院急诊ICU收治的机械通气患者共105例为研究对象,记录所有患者入院时的一般人口学资料(性别、年龄)及合并症(高血压病、糖尿病等),计算并记录急性生理学及慢性健康状况评分系统(APACHEⅡ评分),记录导管留置原因及留置时间,随访患者并记录住院天数及预后,统计分析气管导管末端病原菌的临床特征。结果机械通气患者ICU总体病死率为36.2%。纳入患者气管导管末端检出病原菌105株,其中革兰阳性菌11株,占10.5%;革兰阴性菌86株,占81.9%;真菌8株,占7.6%。病原菌以鲍曼不动杆菌、肺炎克雷伯菌及金黄色葡萄球菌为主。相较于2019年,2020年肺炎克雷伯菌的检出率增加(P<0.001)。鲍曼不动杆菌的检出率在<65岁组和≥65岁组之间,以及导管留置时间≤6 d组和导管留置时间>6 d组之间差异均有统计学意义(P<0.05)。ICU总体病死率随着病原菌菌种的增多而增加(P<0.05)。检出耐药菌50例,均为革兰阴性菌,占所有病原菌株的47.6%(50/105)。耐药菌的发生与导管留置时间呈正相关(r=0.246,P=0.011)。结论机械通气患者气管导管末端病原菌以革兰阴性杆菌占比最高,其中以鲍曼不动杆菌及肺炎克雷伯菌为主;鲍曼不动杆菌的检出率与患者年龄、导管留置时间存在关联,肺炎克雷伯菌检出率有上升趋势;存在复合病原菌的患者,ICU病死率显著增加;耐药菌的发生与导管留置时间密切相关。Objective To explore the clinical characteristics and related influencing factors of endotracheal tube end endotracheal tube end pathogens in patients with mechanical ventilation based on matrix-assisted laser desorption/lonization time of flight mass spectrometry detection.Methods Totally 105 patients who received mechanical ventilation from emergency ICU in Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences from 2019 to 2020 were enrolled.The demographic data(gender,age)and complications(hypertension,diabetes,etc.)of all patients were recorded.Then acute physiology and chronic health evaluation scoring system(APACHEⅡ score)was calculate and record,the reason and the time of catheter indwelling were recorded,the patients were followed up,the length of stay and prognosis were recorded,and the clinical characteristics of pathogens at the end of endotracheal tube were statistically analyzed.Results The overall mortality of patients with mechanical ventilation in ICU was 36.2%,105 strains of pathogenic bacteria were detected at the end of tracheal intubation,including 11 strains of Gram-positive bacteria,accounting for 10.5%;86 strains of Gram-negative bacilli accounted for 81.9%;8 strains of fungi,accounting for 7.6%.The main pathogens were Acinetobacter baumannii,Klebsiella pneumoniae and Staphylococcus aureus.Compared with 2019,the detection rate of Klebsiella pneumoniae increased in 2020(P<0.001).There were significant differences in the detection rate of Acinetobacter baumannii between under 65 years old group and people≥65 years old group,and catheter indwelling time≤6 d group and catheter indwelling time>6 d group(P<0.05).The overall mortality in ICU increased with the increase of kind of pathogenic bacteria(P<0.05).50 cases of drug-resistant bacteria were detected,all of which were Gram-negative bacteria,accounting for 47.6%(50/105)of all pathogenic strains.The occurrence of drug-resistant bacteria was positively correlated with the days of catheter retenti

关 键 词：机械通气 气管导管末端 病原菌 临床特征 相关影响因素 

分 类 号：R446.5[医药卫生—诊断学]