体外心肺复苏患者在ECMO支持期间发生院内获得性感染的危险因素分析  

Clinical risk factors of hospital-acquired infections in the patients treated with extracorporeal cardiopulmonary resuscitation during ECMO support

作　　者：周浩 丁涛 时育彤 张忠满 朱轶 陈旭锋 李伟 Zhou Hao;Ding Tao;Shi Yutong;Zhang Zhongman;Zhu Yi;Chen Xufeng;Li Wei(Emergency and Critical Care Department,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People′s Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)急诊与危重症科,江苏南京210029

出　　处：《中国急救医学》2024年第11期938-942,共5页Chinese Journal of Critical Care Medicine

基　　金：江苏省医学重点学科【苏卫科教(2022)17号】(ZDXK202213);江苏省人民医院临床能力提升工程项目(JSPH-MC-2022-28)。

摘　　要：目的探究体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持期间发生院内获得性感染(hospital-acquired infections,HAI)的危险因素。方法回顾性分析南京医科大学第一附属医院体外生命支持中心ECPR患者83例,根据是否从体液中培养出明确的微生物将患者分为院内获得性感染组(HAI组,n=35)和非院内获得性感染组(nHAI组,n=48),比较其一般资料、实验室检查及预后,用逐步法多因素Logistic回归分析探索相关影响因素。结果83例ECPR患者HAI发生率为42.2%,秩和检验显示,HAI组ECMO置管时间[min:30.0(22.5,40.0)vs.23.5(16.5,30.0)]、总住院时间[d:15.0(10.5,25.5)vs.9.5(4.0,19.3)]、ICU住院时间[d:13.0(9.0,21.5)vs.7.0(3.8,13.0)]、ECMO支持时间[d:6.0(5.1,7.9)vs.5.0(3.2,6.7)]和有创机械通气(invasive mechanical ventilation,IMV)时间[d:11.0(7.0,13.0)vs.5.0(3.0,9.0)]均长于nHAI组(均P<0.05);卡方检验显示,HAI组28 d病死率(60.0%vs.37.5%,P=0.043)、气管切开率(25.7%vs.4.2%,P=0.011)均大于nHAI组;多因素逐步二元Logistic回归分析显示,IMV≥7 d与HAI独立相关(OR=5.016,95%CI 1.659~15.168,P=0.004)。结论ECPR患者ECMO支持过程中发生HAI可能与不良预后相关,HAI发生与IMV≥7 d独立相关。Objective To explore the risk factors of hospital-acquired infections(HAI)in the patients with extracorporeal cardiopulmonary resuscitation(ECPR)during extracorporeal membrane oxygenation(ECMO)support.Methods Clinical data of 83 ECPR patients in Extracorporeal Life Support Center of the First Affliated Hospital of Nanjing Medical University were retrospectively analyzed.The patients were divided into HAI group(n=35)and non-HAI(nHAI,n=48)group according to whether microorganisms were isolated from body fluid culture,and the baseline characteristics,laboratory test and prognosis between the two groups were compared.The independent influencing factors of HAI occurrence were explored by stepwise Logistic regression analysis.Results The incidence of HAI in 83 ECPR patients was 42.2%.The rank sum test indicated that in the HAI group,ECMO catheterization time[min:30.0(22.5,40.0)vs.23.5(16.5,30.0)],hospitalization days[d:15.0(10.5,25.5)vs.9.5(4.0,19.3)],ICU days[d:13.0(9.0,21.5)vs.7.0(3.8,13.0)],duration of ECMO support[d:6.0(5.1,7.9)vs.5.0(3.2,6.7)]and duration of invasive mechanical ventilation(IMV)[d:11.0(7.0,13.0)vs.5.0(3.0,9.0)]were longer than those in nHAI group(all P<0.05).Chi-square test showed that the 28-day mortality(60.0%vs.37.5%,P=0.043)and the probability of tracheotomy(25.7%vs.4.2%,P=0.011)in the HAI group were higher than those in the nHAI group.Multivariate stepwise binary Logistic regression analysis showed that IMV≥7 days was independently correlated with HAI(OR=5.016,95%CI 1.659-15.168,P=0.004).Conclusions The occurrence of HAI during ECMO support in ECPR patients may be associated with poor prognosis,and our study finds that HAI is independently associated with IMV≥7 days.

关 键 词：体外心肺复苏 体外膜肺氧合 院内获得性感染 预后 有创机械通气 

分 类 号：R459.7[医药卫生—急诊医学]