老年肺癌切除术后多重耐药鲍曼不动杆菌感染的影响因素分析及预防措施

Infl uencing factors and intervention measures of multidrug-resistant acinetobacter baumannii infection after resection of lung cancer in elderly

目的 探讨老年肺癌切除术后多重耐药鲍曼不动杆菌(MDR-AB)感染的影响因素,并对护理干预进行分析。方法 选取2020年1月—2022年1月120例肺癌术后鲍曼不动杆菌感染的老年患者作为研究对象,根据药敏试验分为非MDR-AB组与MDR-AB组,比较两组患者临床特征差异,采用多因素Logistic回归分析出现MDR-AB的危险因素。结果 120例鲍曼不动杆菌感染患者中有18例药敏试验病原菌为MDR-AB,占15.00%;102例为非MDR-AB感染,占85.00%。单因素分析显示,MDR-AB组年龄、合并糖尿病、呼吸系统疾病、中心静脉置管、碳氢酶烯类暴露、头孢菌素类暴露、抗菌药物使用种类≥2种、抗菌药物使用时间≥7 d及APACHEⅡ评分均高于非MDR-AB组,差异有统计学意义(P<0.05)。实验室指标比较,MDR-AB组Hb、Alb低于非MDR-AB组,差异有统计学意义(P<0.05), WBC、PCT、CRP高于非MDR-AB组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:APACHEⅡ评分≥16.97分、合并呼吸系统疾病、碳氢酶烯类暴露、头孢菌素类暴露、抗菌药物使用种类≥2种、抗菌药物使用时间≥7d、Hb≤110.67 g/L、Alb≤33.34 g/L是MDR-AB感染发生的危险因素。结论 基础疾病、侵入性操作、抗菌药物使用、营养状况差等是增加老年肺癌术后MDR-AB感染的危险因素,为避免MDR-AB的发生在临床护理过程中要给予积极的预防。

Objective To explore the influencing factors of multidrug-resistant Acinetobacter baumannii(MDRAB)infection after resection of lung cancer in the elderly and to analysis the nursing intervention.Methods 120 elderly postoperative MDR-AB infection after lung cancer resection were selected as study subjects from January 2020 to January 2022,they were divided into non-MDR-AB group and MDR-AB group according to drug sensitivity test,comparing the diff erences in clinical characteristics between the two groups,and to analysing the risk factors for the emergence of MDR-AB by multifactorial logistic regression.Results Among 120 patients with acinetobacter baumannii infections,18 cases of drug sensitivity test pathogens were MDR-AB,accounting for 15.00%.102 cases were non-MDR-AB infections,accounting for 85.00%.Univariate analysis showed that age,comorbid diabetes mellitus,respiratory disease,central venous catheterisation,carbapenem exposure,cephalosporin exposure,antimicrobial use of≥2 types,duration of antimicrobial use of≥7 d,and APACHE II scores were higher in MDR-AB than in the non-MDR-AB group,the difference was statistically significant(P<0.05).Comparison of laboratory indicators,Hb and Alb were lower in the MDR-AB group than in the non-MDR-AB group,and the diff erence was statistically signifi cant(P<0.05),and WBC,PCT and CRP were higher than in the non-MDRAB group,and the diff erence was statistically signifi cant(P<0.05).Multifactorial logistic regression analysis showed that APACHE II score≥16.97,combined respiratory diseases,carbapenem exposure,cephalosporin exposure,antimicrobial drug use≥2 types,antimicrobial drug use time≥7 d,Hb≤110.67 g/L,and Alb≤33.34 g/L were the risk factors for the occurrence of MDR-AB infection.Conclusion Basic diseases,invasive operations,antimicrobial drug use and poor nutritional status were the risk factors that increase the incidence of MDR-AB infections after lung cancer surgery in the elderly,to avoid the occur of MDR-AB,the positive intervention should be given dutring the clinical nursing.