连续性肾脏替代治疗患者并发医院获得性肺炎的临床特征及相关因素分析

Pathogens causing the hospital acquired pneumonia in CRRT patients and analysis of the related factors

目的：探讨连续性肾脏替代治疗（ CRRT）患者医院获得性肺炎病原学特点及相关因素。方法采用回顾性研究方法，选取2009－09～2014－07恩施州中心医院血透中心进行CRRT患者580例，分析并发肺部感染的病原菌、感染率及相关因素。结果580例CRRT患者中发生医院获得性肺炎58例，感染率为10．0％。病原菌以葡萄球菌感染为主。年龄、治疗时间、基础疾病、吞咽障碍、器官衰竭数目、意识障碍、预防应用抗菌药与CRRT患者并发肺部感染相关（P＜0．05）。其中年龄≥60岁（β＝0．59，OR＝3．79）、治疗时间≥24 h（β＝1．12，OR＝2．46）、基础疾病≥2种（β＝2．79，OR＝4．10）、器官衰竭数目≥3种（β＝3．284，OR＝12．70）、意识障碍（β＝2．35，OR＝3．26）是CRRT患者并发肺部感染的危险因素。预防应用抗菌药物（β＝－1．72，OR＝0.18）是CRRT患者并发肺部感染的保护因素。结论 CRRT患者并发肺部感染与多种因素密切相关，临床应针对性地采取预防及干预措施，有效控制医院感染的发生，提高患者治疗的安全性。

Objective To explore the infectious pathogen and related factors of hospital acquired pneumonia in continuous renal replacement therapy （ CRRT ） and providing the basis for the development of nursing measures and intervention measures . Methods In order to analyze the incidence of nosocomial infections and pathogen and the related factors , this retrospective investigation collected the clinical data from 580 CRRT patients who were hospitalized to the center of hemodialysis units of our university from Sep .2009 to July.2014.Results The nosocomial infections were occurred in 58 cases of the 580 cases, and the infectious rate was 10.0%;the main pathogen was staphyloccocus aureus;the related factors （P〈0.05） included age, therapy times, the basis of disease, dysphagia, the number of organ failure , disorder of consciousness , preventive application of antibiotics , and the risk factors included the age which is greater than or equal to sixty years （β=0.59, OR=3.79）, therapy times which is greater than or equal to twenty four hours （β=1.12, OR=2.46）, the basis of disease which is greater than or equal to twice types （β=2.79, OR=4.10）, the number of organ failure （β=3.284, OR=12.70）, disorder of consciousness which is holding （β=2.35, OR=3.26） and the protective factors including preventive application of antibiotics （β=-1.72, OR =0.18 ） were analyzed.Conclusion The hospital acquired pneumonia in CRRT patients is closely related to the number of factors .The appropriate intervention measures should be taken clinically to effectively control the occurrence of infections and enhance the treatment safety of patients .