体外膜肺氧合患者医院感染的特征与防控策略  

Characteristics and prevention and control strategies of nosocomial infection in patients with extracorporeal membrane oxygenation

作　　者：黄奉毅 付显芬 冉红芬 高佳佳 冉茂林 HUANG Fengyi;FU Xianfen;RAN Hongfen;GAO Jiajia;RAN Maolin(Department of Hospital Infection Management,People's Hospital of Changshou Chongqing,Changshou Hospital of The First Affiliated Hospital of Chongqing Medical University,Chongqing 401220,China;Department of Orthopedics and Traumatology,Changshou Hospital of Traditional Chinese Medicine,Chongqing 401220,China)

机构地区：[1]重庆市长寿区人民医院、重庆医科大学附属第一医院长寿医院医院感染管理科,重庆401220 [2]重庆市长寿区中医院骨伤科,重庆401220

出　　处：《医药前沿》2025年第9期11-15,共5页Journal of Frontiers of Medicine

基　　金：重庆市长寿区科技计划项目(CSKJ2024021)。

摘　　要：目的了解体外膜肺氧合(ECMO)患者医院感染的特征,为制定预防控措施提供参考依据。方法检索中国知网、万方数据知识服务平台、维普网、Web of Science、PubMed数据库中发表的ECMO医院感染相关文献,检索时间从建库至2024年8月,由2名研究者独立筛选并交叉核对,然后对相关数据进行汇总分析。结果共纳入ECMO医院感染文献26篇,涉及2259例接受ECMO治疗的患者,其中847例发生953例次医院感染,医院感染发病率为37.49%,例次发病率为42.19%。感染类型以下呼吸道和血流为主,分别占42.39%和25.71%。感染病原体包括细菌、病毒、真菌3大类。其中,细菌感染占首位(89.3%),其次为真菌感染(9.7%)。细菌感染中以革兰阴性菌为主,包括鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌。病原体在不同感染部位存在差异。单因素及多因素Logistic回归分析显示,ECMO患者医院感染的危险因素包括患者本身免疫力低下、ECMO辅助期间皮肤屏障破坏以及各种有创操作。结论ECMO医院感染是ECMO辅助期间常见的并发症。需重点关注ECMO患者医院感染常见部位、常见病原体和高危因素,针对性评估患者的高危因素,落实ECMO上机前、中、后医院感染防控措施,以最大限度减少ECMO辅助期间医院感染的发生。Objective To investigate the characteristics of nosocomial infections in patients with extracorporeal membrane oxygenation(ECMO)in order to provide a reference for the establishment of prevention and control measures.Methods Literatures related to ECMO nosocomial infections which published in databases including CNKI,Wanfang Data Knowledge Service Platform,VIP,Web of Science,and PubMed from the establishment of the databases to August 2024 were retrieved.Two researchers independently screened and cross-checked,and then a comprehensive analysis was completed in the relevant data.Results A total of 26 literatures on ECMO nosocomial infections were included,involving 2259 patients receiving ECMO treatment,among whom 847 patients had 953 times of nosocomial infections.The nosocomial infection incidence rate was 37.49%,and the case-incidence rate was 42.19%.The main types of infection were the lower respiratory tract and bloodstream,which accounted for 42.39%and 25.71%,respectively.The infectious pathogens included 3 major groups of bacteria,viruses,and fungi.Among them,bacterial infection accounted for the first(89.3%),followed by fungal infection(9.7%).Among bacterial infections,Gram-negative bacteria were predominant,including Acinetobacter baumannii,Klebsiella pneumoniae,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,and Staphylococcus aureus.Pathogens were different in different infection sites.Univariate and multivariate Logistic regression analyses showed that risk factors of nosocomial infections in ECMO patients included compromised immunity,skin barrier disruption during ECMO support,and various invasive procedures.Conclusions Nosocomial infections are common complications during ECMO support.It is necessary to focus on the common infection sites,common pathogens,and risk factors in ECMO patients.High-risk factors of ECMO patients should be targeted assessments,and prevention and control measures of nosocomial infection should be implemented before,during,and after ECMO initiation so as to minimize the

关 键 词：体外膜肺氧合 医院感染 病原体 危险因素 预防控制 

分 类 号：R563[医药卫生—呼吸系统]