RICU患者耐甲氧西林金黄色葡萄球菌定植特点与护理

MRSA colonization characteristics and nursing of patients in RICU

目的探讨呼吸重症监护病房（RICU）患者MRSA体表定植的特点及对患者预后的影响，为RICU患者临床护理的方法提供依据。方法前瞻性研究，纳入首都医科大学附属北京同仁医院RICU2010年1月至2011年11月收治的患者246例。患者入院当日以拭子留取鼻腔、咽后壁、腋窝、腹股沟、前胸部和手等部位的微生物标本并进行耐甲氧西林金黄色葡萄球菌（MRSA）培养，且此后每3天重复1次。根据MRSA培养结果将患者分为MRSA定植组30例与MRSA非定植组216例，分析两组患者性别、年龄、APACHEⅡ评分、APACHEⅢ评分、1年内住院次数及病死率的差异，并分析MRSA的定植部位。结果RICU患者MRSA定植率为12．19％，其中16例为院内获得性定植。MRSA定植组和非定植组在性别组成、APACHEⅡ评分和APACHEⅢ评分方面差异无统计学意义（P〉0．05）；MRSA定植组平均年龄显著大于非定植组[（81．13±6．86）岁比（74．78±11．89）岁；t=2．955，P=0．003）]；MRSA定植组1年内住院次数和病死率分别为（1．83±1．206）次，40．0％均显著高于MRSA非定植组的（1．06±0．257）次，16．7％，差异均有统计学意义（t=2．998，χ2=：9．132；P〈0．01）。MRSA定植患者定植部位以鼻腔为主。结论MRSA的定植对RICU患者的预后有着重要影响；MRSA定植的患者中，50％以上的患者是在医院内形成定植的，应该加强床旁护理，预防交叉感染。

Objective To investigate the characteristics of MRSA colonization and their influence to the prognosis of patients in respiratory intensive care unit （ RICU）, so as to provide the basis for the caring of the RICU patients. Methods A prospective study included 246 cases of patients admitted to RICU in our hospital during Jan 2010 to Neb 2011. Swab specimens from nares, pharynx, axillae, groin, chest and hands of the patients were collected and cultured at the first day in RICU, and then repeated every 3 days. The patients were divided into MRSA colonization group （ n= 30 ） and MRSA non-colonization group （ n = 216 ） according to MRSA culture results. Results The MRSA colonization rate was 12.19% in RICU patients, including 16 cases of hospital-acquired colonization. No significant difference was found in the gender, the APACHE Ⅱscore and APACHE Ⅲ between MRSA colonization group and the MRSA non-colonization group （ P 〉 0.05 ）. The mean age in MRSA colonization group was significantly greater than that of the MRSA non-colonization group [ （81.13 ±6.86） vs （74.78± 11.89） ;t =2. 955 ,P =0.003） ] ; The number of hospitalization and the mortality in one year of the MRSA colonization group was significantly more than those of MRSA non-colonization group [（1.83±1.216） vs （1.06 ±0.257）,40.0% vs16.7%;t=2.998χ2=9.132;P〈0.01）]. MRSA was mainly colonized in nares. Conclusions MRSA colonization has an important impact on the prognosis of RICU patients. More than 50% of MRSA colonization cases are hospital-associated, suggesting that we should strengthen the bedside care, prevention of cross infection.