重症监护病房获得性败血症患者预后危险因素的分析与护理

Analysis of risk factors on patients with acquired septicemia in ICU and its nursing

目的探讨重症监护患者获得性败血症的发生、菌种、影响预后的危险因素及护理对策。方法回顾性分析2004年12月至2009年6月入住ICU后确诊发生败血症的48例患者的病原菌培养结果及临床资料。结果本次调查中ICU败血症发病率为1．01％，死亡率为47．9％；56株致病菌中革兰阳性菌占42．8％，革兰阴性菌占39．3％，真菌占17．9％；年龄≥60岁、APACHE Ⅱ高评分、低蛋白血症、应用肠外营养是影响ICU败血症预后的危险因素。结论护理人员应加强年龄／〉60岁、高APACHEⅡ评分、低蛋白血症等获得性败血症患者的相关护理及营养管理，以改善预后。

Objective To investigate the category of pathogenic bacteria, clinical features, risk factors affecting prognosis and related nursing procedure of septicemia in ICU. Methods Retrospective study of a cohort of septicemia patients （ n = 48） admitted to ICU between December 2004 and June 2009, with assessment of 8 potential risk factors for mortality by univariate analysis. Results The incidence of septicemia was 1. 01% , and the morality was 47.9% （23/48）. Among 56 strains of pathogen G^＋ , G^- and fungi accounted for 42.8% （24/56）, 39.3% （22/56） and 17.9% （10/56） , respectively. By univariate analysis, several variables were proved to be statistically significant, including age≥ 60 years （ OR = 1. 957 and 95% CI = 1. 156 - 3. 311 ） , plasma albumin 〈 30 g/L （ OR = 1. 630 and 95% CI = 1. 028 - 2. 586 ） and parenteral nutrition （ OR = 2. 536 and 95% CI = 1. 174 - 5. 481 ）. Conclusions The nursing staff should pay more attention to the septicemia patients with age≥60 years, plasma albumin 〈 30 g/L and parenteral nutrition to improve the outcome of septicemia.