肺部感染所致急性呼吸窘迫综合征的预后危险因素与病原学分析

Prognostic risk factors and etiology of acute respiratory distress syndrome due to pulmonary infection

目的探讨影响肺部感染所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后的危险因素及感染病原菌的耐药性特点。方法对2005年1月-2012年8月我院收治的81例肺部感染所致ARDS患者进行预后危险因素分析,同时分析病原菌构成和耐药性特点。结果纳入分析患者病死率50.6%,多因素Logistic回归分析表明序贯器官功能衰竭评分(sequential organ failure assessment,SOFA)、氧合指数和ICU住院<7 d是影响肺部感染所致ARDS预后的危险因素。共检测出73株病原菌,革兰阴性菌60株(82.2%),其中鲍曼不动杆菌40株(66.7%),对头孢二代、三代、碳青霉烯类等耐药率>95%。结论 SOFA评分、氧合指数和ICU住院<7 d是影响肺部感染所致ARDS预后的危险因素,感染病原菌以革兰阴性杆菌为主,泛耐药的鲍曼不动杆菌检出率较高。

Objective To study the risk factors for prognosis of acute respiratory distress syndrome（ARDS） and its drug resistance to pathogenic bacteria.Methods The risk factors for prognosis,pathogenic bacteria and their drug resistance in 81 patients with ARDS due to pulmonary admitted to our hospital from January 2005 to August 2012 were analyzed.Results The mortality of the patients was 50.6%.Multivariate logistic regression analysis showed that sequential organ failure assessment（SOFA） score,oxygenation index（PaO2/FiO2 ratio） and ICU stay time7 days were the risk factors for the prognosis of ARDS due to pulmonary infection.Of the detected 73 strains of pathogenic bacteria,62（82.2%） including 40 strains（66.7%） of Pseudomonas aeruginosa were Gram-negative with a drug resistance rate95% to the second and third generation of cephalosporin and carbapenems.Conclusion SOFA score,oxygenation index（PaO2/FiO2 ratio） and ICU stay time7 days are the risk factors for prognosis of ARDS due to pulmonary infection.Gram-negative bacilli are the main pathogenic bacteria.The positive detection rate of multidrug-resistant Pseudomonas aeruginosa is rather high.