创伤后ARDS机械通气患者早期肺部感染危险因素分析

Risk factors for early lung infection in post-traumatic ARDS patients with mechanic ventilation

目的研究探讨创伤后ARDS机械通气患者早期并发肺部感染的危险因素。方法选取2010年1月至2013年12月从我院ICU收治的创伤后ARDS机械通气患者67例,分为肺部感染组和非肺部感染组,30位健康志愿者作为正常对照组。结果 64例严重创伤后并发ARDS患者入选,肺部感染1例。三组患者性别构成和年龄差异无统计学意义(P>0.05);急性生理与慢性健康评分(APACHEⅡ)、创伤严重程度评分(ISS)和30天死亡率比较,肺感染组显著高于非肺感染组间(P<0.05);氧合指数、呼吸机通气时间、人工气道留置时间和ICU治疗时间,非肺部感染组与肺部感染组之间差异有统计学意义(P<0.01);肺感染组胸部损伤的构成比显著高于非肺部感染组,差异有统计学意义(P<0.05);和正常对照组比较,肺部感染组和非肺部感染组的血清C反应蛋白(CRP)、降钙素原(PCT)和可溶性髓样细胞触发受体-1(s TREM-1)水平显著升高,差异有统计学意义(P<0.01),肺部感染组血清CRP、PCT和s TREM-1水平比非肺部感染组的显著升高,差异有统计学意义(P<0.05);和正常对照组比较,非肺部感染组和肺部感染组的支气管肺泡灌洗(BAFL)s TREM-1水平显著升高,差异有统计学意义(P<0.01),肺部感染组BAFL的CRP、PCT和s TREM-1水平比非肺部感染组的显著升高,差异有统计学意义(P<0.05)。单因素logistic回归分析显示胸部损伤、ISS评分、APACHEⅡ评分、血清的CRP、PCT和s TREM-1水平以及BAFL的s TREM-1水平影响因素;多因素logistic回归分析显示APECHEⅡ评分及BAFL的s TREM-1水平。结论胸部损伤、ISS评分、血清的CRP、PCT和s TREM-1水平可在一定程度上可预测早期肺部感染,但只有APACHEⅡ评分和BAFL的s TREM-1水平是创伤后ARDS患者早期并发肺部感染的独立危险因素。

Objective To investigate the risk factors for lung infection in post-traumatic ARDS patients with mechanic ventilation.Methods 67 patients who were admitted by our hospital＇s ICU department because of post-traumatic ARDS from January,2010 to December,2013 were randomly divided into two groups,the infected group and the non-infected group. 30 healthy volunteers were selected as the control group.Results 64 sever post-traumatic ARDS patients were chosen among which 34 were lung infected and 30 were not. The infected rate was 53%. There were no significance of sex composition and age among three groups（ P〈0.05）. APACHEⅡ,ISS,30-day mortality,the constituent ratio of thoracic injury,the serum level of CRP,PCT and sTREM-1 of the infected group were much higher than the non infected group（ P〈0.05）.There was significance of Oxygenation index,the time of mechanic ventilation,Artificial airway indwelling and ICU staying between the infected and non infected group（ P〈0.01）. Compared with the control group,the serum level of CRP,PCT and s TREM-1 of the infected and non infected group were significantly increased（ P〈0.05）,and the level of s TREM-1 after BAFL were significantly increased as well（ P0.01）. The level of CRP,PCT and s TREM-1 after BAFL in the infected group were significantly higher than the non infected group（ P〈0.05）.Univariate logistic regression analysis showed that factors whose p-value were less than 0.05 were the thoracic injury,ISS,APACHE Ⅱ,the level of CRP,PCT and s TREM-1 and the level of s TREM-1 after BAFL. Multi-factor logistic regression analysis showed that factors whose p-value were less than 0. 05 were the APACHE Ⅱ and the level of s TREM-1 after BAFL.Conclusion Thoracic injury,ISS,the serum level of CRP,PCT and s TREM-1 can predict the lung infection in some degree. But only the APACHEⅡand the serum level of BAFL and s TREM-1 are the independent risk factors for lung infection.