ECMO辅助的急性心肌梗死患者院内感染临床特征及风险因素研究  

Clinical characteristics and risk factors of in-hospital infections in acute myocardial infarction patients assisted with ECMO

作　　者：黄明君[1] 尹礼义 刘莉 代大华 胡聪龙 Huang Mingjun;Yin Liyi;Liu Li;Dai Dahua;Hu Conglong(ECMO Center,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,China;Department of Emergency Medicine,Hunan Provincial People's Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha,China;Department of Intensive Care Medicine,Xingyi People's Hospital of Guizhou Province;Department of Intensive Care Medicine,Affiliated Hospital of Zunyi Medical University,Zunyi,China)

机构地区：[1]郑州大学第一附属医院ECMO中心 [2]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科 [3]贵州省兴义市人民医院重症医学科 [4]遵义医科大学附属医院重症医学科

出　　处：《实用休克杂志(中英文)》2024年第6期347-351,共5页Journal of Practical Shock

摘　　要：目的 对单中心接受静脉-动脉体外膜肺氧合的急性心肌梗死并发心源性休克患者中院内感染的临床特征及危险因素研究,为临床工作提供参考经验。方法 回顾性分析78例需要体外生命支持的急性心肌梗死并发心源性休克的成人患者,根据是否发生院内感染进行分组。分析两组的临床基线资料、ECMO临床特征、院内感染临床特征、院内感染病原菌及分布、院内感染的危险因素。结果 首次院内感染的中位时间为ECMO开始后135.5h(P=0.006),院内感染组的死亡率高于非感染组(P=0.022)。机械通气时间越长,院内感染发生率越高(P=0.049)。革兰阴性菌是ECMO患者院内感染的主要病原体,占44.8%(13/29)。感染部位主要来源于呼吸道,其次是血流感染。既往心肌梗死病史患者院内感染风险增加6.6倍。CRRT的应用使院内感染风险增加3.6倍。ECMO期间心脏并发症事件的发生使院内感染风险增加6.3倍。ECMO运行时间越长,院内感染风险越高。结论 呼吸机相关性肺炎和血流感染是接受ECMO治疗的急性心肌梗死并发心源性休克患者中常见的院内感染类型,革兰氏阴性菌是主要病原体。ECMO运行时间越长,感染风险可能越高。既往心肌梗死病史、ECMO期间出现急性肾衰竭及心脏并发症事件的患者可能有较高感染发生率。Objective To investigate the clinical characteristics and risk factors of nosocomial infections in patients with acute myocardial infarction complicated by cardiogenic shock receiving venoarterial extracorporeal membrane oxygenation at a single center,providing reference experience for clinical practice.Methods A retrospective analysis of 78adult acute myocardial infarction complicated by cardiogenic shock patients requiring extracorporeal life support was conducted.Patients were grouped based on the occurrence of nosocomial infections.Clinical baseline data,ECMO clinical characteristics,nosocomial infection characteristics,pathogens and distribution of nosocomial infections,and risk factors for nosocomial infections were analyzed between the groups.Results The median time to the first nosocomial Infection was 135.5hafter the start of ECMO(P=0.006).The mortality rate was higher in the nosocomial Infection group than in the non-infection group(P=0.022).Longer mechanical ventilation duration was associated with a higher incidence of nosocomial Infection(P=0.049).Gram-negative bacteria were the main pathogens of nosocomial Infection in ECMO pa-tients,accounting for 44.8%(13/29).The primary infection sites were the respiratory tract,followed by bloodstream infections.A history of myocardial infarction increased the risk of nosocomial Infection by 6.6times.The use of continuous renal replacement therapy(CRRT)increased the risk of nosocomial Infection by 3.6times.The occurrence of cardiac complications during ECMO increased the risk of nosocomial Infection by 6.3times.The longer the duration of ECMO,the higher the risk of nosocomial Infection.Conclusions Ventilator-associated pneumonia and bloodstream infections are common types of nosocomial Infection in acute myocardial infarction complicated by cardiogenic shock patients receiving ECMO treatment,with Gram-negative bacteria being the main pathogens.The longer the ECMO duration,the higher the risk of infection.Patients with a history of myocardial infarction,acute ren

关 键 词：体外膜肺氧合 急性心肌梗死 院内感染 

分 类 号：R542.22[医药卫生—心血管疾病]