影响呼吸衰竭患者ECMO治疗期间发生血流感染的危险因素分析  

Analysis of risk factors for bloodstream infections during ECMO treatment in patients with respiratory failure

作　　者：黄康 吕建磊 刘敏 戴瑶 HUANG Kang;LYU Jianlei;LIU Min;DAI Yao(Department of Respiratory and Critical Care Medicine,The Affiliated Changsha Hospital of Xiangya School of Medicine,Central South University,Changsha 410005,China)

机构地区：[1]中南大学湘雅医学院附属长沙医院重症医学科,湖南长沙410005

出　　处：《医用气体工程》2025年第1期27-29,共3页Medical Gases Engineering

基　　金：2025年湖南省自然科学基金项目(2025JJ80496)。

摘　　要：目的:探讨影响呼吸衰竭患者体外膜肺氧合(ECMO)治疗期间发生血流感染的危险因素。方法:我院2020年3月—2024年2月收治的60例行ECMO呼吸衰竭的患者,观察所有呼吸衰竭患者启动ECMO 24 h至撤机48 h内发生血流感染的情况。18例呼吸衰竭患者出现血流感染为感染组,其余42例为未感染组。观察两组血培养、血小板输注量、悬浮红细胞输注量、肺损伤Murrary评分及序贯器官衰竭估计(SOFA)评分。结果:两组合并自身免疫病及糖尿病比例、年龄、ECMO成功撤机比例、ECMO支持时间、性别、SOFA评分经比较差异均无统计学意义(P>0.05);感染组的肺损伤Murrary评分高于未感染组(P<0.05);感染组ECMO治疗期间血小板输注量、悬浮红细胞输注量均高于非感染组(P<0.05)。经过多因素logistic回归分析显示,肺损伤Murrary评分(OR=1.694,P=0.000)、血小板输注量(OR=1.230,P=0.013)、悬浮红细胞输注量(OR=1.145,P=0.001)。结论:鲍曼不动杆菌与肺炎克雷伯杆菌为造成呼吸衰竭患者ECMO治疗期间发生血流感染的主要病原体,血小板输注量及悬浮红细胞输注量过高、肺损伤Murrary评分升高为ECMO治疗期间出现血流感染的独立危险因素。Objective:To explore the risk factors for bloodstream infections during extracorporeal membrane oxygenation(ECMO)treatment in patients with respiratory failure.Methods:From March 2020 to February 2024,60 patients with respiratory failure undergoing ECMO admitted to our hospital were observed for the occurrence of bloodstream infections within 24 h from ECMO initiation to 48 h after ECMO withdrawal.A total of 18 patients with respiratory failure who developed bloodstream infections were in the infected group,while the remaining 42 patients were in the uninfected group.Blood cultures,platelet transfusion volume,suspended red blood cell transfusion volume,Murrary lung injury score,and Sequential Organ Failure Assessment(SOFA)score were observed.Results:There was no significant difference between the two groups in the proportion of autoimmune diseases and diabetes,age,ECMO successful weaning ratio,ECMO support time,gender,and SOFA score(P>0.05).The Murrary lung injury score in the infected group was higher than that in the uninfected group(P<0.05).During ECMO treatment,the platelet transfusion volume and suspended red blood cell transfusion volume in the infected group were higher than those in the uninfected group(P<0.05).Multivariate logistic regression analysis showed that the Murrary lung injury score(OR=1.694,P=0.000),platelet transfusion volume(OR=1.230,P=0.013),and suspended red blood cell transfusion volume(OR=1.145,P=0.001)were found.Conclusion:Acinetobacterbaumannii and Klebsiella pneumoniaeare the main pathogens causing bloodstream infections during ECMO treatment in patients with respiratory failure.Excessive platelet transfusion volume and suspended red blood cell transfusion volume,as well as elevated Murrary lung injury score,are independent risk factors for bloodstream infections during ECMO treatment.

关 键 词：呼吸衰竭 血流感染 体外膜肺氧合 血培养 

分 类 号：R47[医药卫生—护理学]