论文部分内容阅读
目的分析体外膜肺氧合(ECMO)支持患者的医院感染因素。方法收集广东省中山市人民医院2009年1月至2014年3月行ECMO支持患者的医院感染资料,并进行回顾性分析。结果75例患者中发生医院感染20例,感染率26.7%。分离病原菌58株,其中革兰阴性菌43株(74.1%),革兰阳性菌15株(25.9%)。多重耐药菌株高度集中,以鲍曼不动杆菌(21株,36.2%)、铜绿假单胞菌(18株,31.0%)和凝固酶阴性葡萄球菌(11株,20.0%)为主。感染组平均住院时间为36.5d,显著长于非感染组的7.0d,差异有统计学意义(Z=-2.090,P<0.05);感染组ECMO支持时间>48h者占95.0%,显著高于非感染组的52.7%,差异也有统计学意义(χ~2=11.375,P=0.001)。ECMO支持时间延长会延长住院时间,但未增加病死率;高水平乳酸增加患者的病死率(Z=-2.598,P<0.05)。结论行ECMO支持治疗继发感染与住院时间、ECMO支持时间有明显相关性,医院应对此作出相应的预防措施,减少ECMO继发感染的发生。
Objective To analyze the nosocomial infections in patients with extracorporeal membrane oxygenation (ECMO). Methods The data of nosocomial infection from patients in ECMO from January 2009 to March 2014 in Zhongshan People’s Hospital of Guangdong Province were collected and analyzed retrospectively. Results Among 75 patients, nosocomial infection occurred in 20 cases and the infection rate was 26.7%. 58 strains of pathogens were isolated, of which 43 were gram-negative bacteria (74.1%) and 15 were gram-positive bacteria (25.9%). Multidrug-resistant strains were highly concentrated, and Acinetobacter baumannii (21 strains, 36.2%), Pseudomonas aeruginosa (18 strains, 31.0%) and coagulase-negative staphylococci (11 strains, 20.0%) were predominant. The average length of hospital stay was 36.5 days in infection group, which was significantly longer than that in non-infected group at 7.0 days (Z = -2.090, P <0.05). In ECMO infection group, 95.0% In the infected group, 52.7% of the patients had significant difference (χ ~ 2 = 11.375, P = 0.001). ECMO support extended hospital stay, but no increase in mortality; high levels of lactic acid increased mortality (Z = -2.598, P <0.05). Conclusion ECMO supportive treatment of secondary infection and hospitalization time, ECMO support time was significantly related to the hospital should take appropriate precautions to reduce the incidence of secondary ECMO infection.