脊髓损伤患者康复期尿路感染特点及相关因素分析  

Characteristics and related factors of urinary tract infections during the rehabilitation phase in patients with spinal cord injury

作　　者：张佳熠 李诗欣 骆沁熹 杨永红[1,2] Zhang Jiayi;Li Shixin;Luo Qinxi(Department of Rehabilitation Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院康复医学中心,成都610041 [2]康复医学四川省重点实验室,成都610041

出　　处：《中国康复》2025年第4期217-222,共6页Chinese Journal of Rehabilitation

基　　金：四川省科技计划项目(2024NSFSC0539)。

摘　　要：目的:探讨脊髓损伤(SCI)患者在康复期发生尿路感染(UTI)的特点及相关因素。方法:回顾性分析在我院康复医学科接受治疗的2101例SCI患者的电子病历数据,收集患者人口学信息、临床特征和实验室指标,分为无感染组、无症状性菌尿(ASB)组和症状性UTI组,利用多分类Logistic回归分析探讨UTI发病的相关因素。结果:SCI患者中UTI的发生率为74.0%,其中ASB和症状性UTI的发生率分别为41.8%和32.9%。实验室指标分析显示,症状性UTI患者的炎性指标显著高于无感染组和ASB组。多分类Logistic回归分析表明,女性(ASB:OR=2.66;症状性UTI:OR=1.96)和神经源性膀胱(ASB:OR=1.97;症状性UTI:OR=3.94)为ASB和症状性UTI的共同危险因素。留置导尿(OR=2.17)、并发肾脏损伤(OR=1.35)、使用抗胆碱能药物(OR=1.39)与症状性UTI密切相关。较低的损伤等级和并发肺部感染对UTI的发生具有保护作用,D级损伤(OR=0.54)和并发肺部感染(OR=0.58)显著降低ASB的发生风险,C级(OR=0.57)、D级(OR=0.28)和E级损伤(OR=0.47)显著降低症状性UTI的发生风险。结论:SCI患者在康复期内UTI的发生率较高,ASB和症状性UTI有不同的临床特点和危险因素。应针对不同类型的UTI采取差异化的预防和治疗策略,加强对高危患者的监测与干预,以改善生活质量。Objective:To investigate the characteristics and risk factors associated with urinary tract infections(UTI)during the rehabilitation phase in patients with spinal cord injury(SCI).Methods:A retrospective analysis was conducted on electronic medical records of 2101 SCI patients treated in our rehabilitation department from 2013 to 2023.Demographic information,clinical features,and laboratory indicators were collected through the electronic medical record system.Patients were categorized into a non-infection group,an asymptomatic bacteriuria(ASB)group,and a symptomatic UTI group based on their UTI status.Multinomial logistic regression was used to analyze risk factors associated with UTI.Results:The incidence of UTI in SCI patients was 74.0%,41.8%in ASB group and 32.9%in symptomatic UTI group.Laboratory analysis indicated that inflammatory markers were significantly higher in symptomatic UTI patients than in the no-infection and ASB groups.Multinomial logistic regression revealed that female gender(ASB:OR=2.66;symptomatic UTI:OR=1.96)and neurogenic bladder(ASB:OR=1.97;symptomatic UTI:OR=3.94)were shared risk factors for both ASB and symptomatic UTI.Indwelling catheterization(OR=2.17),renal impairment(OR=1.35),and anticholinergic drug use(OR=1.39)were significantly associated with symptomatic UTI.Lower injury levels and coexisting pulmonary infections appeared protective against UTI,with D-level injury(OR=0.54)and pulmonary infections(OR=0.58)significantly reducing ASB risk,and C-level(OR=0.57),D-level(OR=0.28),and E-level(OR=0.47)injuries significantly lowering the risk of symptomatic UTI.Conclusion:The incidence of UTI is high among SCI patients during the rehabilitation phase,with distinct clinical features and risk factors for ASB and symptomatic UTI.Differentiated prevention and treatment strategies should be implemented based on the type of UTI,with enhanced monitoring and intervention for high-risk patients to improve quality of life.

关 键 词：脊髓损伤 尿路感染 无症状性菌尿 症状性尿路感染 危险因素 康复期 

分 类 号：R49[医药卫生—康复医学] R744[医药卫生—临床医学]