老年重症加强监护病房内血流感染危险因素的探讨

The risk factors of bloodstream infection in the elderly intensive care unit

目的研究影响老年重症加强监护病房血流感染(blood stream infection,BSI)发生的相关危险因素,为临床防治提供依据。方法选取2014年3月-2016年2月老年重症加强监护病房患者384例,其中BSI患者89例。采用回顾性研究方法,分析BSI发生的相关危险因素并进行Logstic回归分析。结果年龄≥70岁、高血糖、意识障碍、急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)评分≥17分和血清白蛋白<40g/L患者的BSI发生率分别为32.02%、40.96%、43.33%、27.31%、34.67%,均高于年龄<70岁、无高血糖、无意识障碍、APACHEⅡ评分<17分及血清白蛋白≥40g/L患者的15.53%、18.27%、17.01%、17.86%、20.13%;静脉置管的284例患者中,行股静脉置管、置管次数≥2次和留置时间≥7d的患者感染发生率分别为43.24%、34.88%、42.19%,均高于行锁骨下静脉置管、置管次数1次及留置时间<7d患者的27.14%、20.29%、18.64%。Logistic回归分析结果显示,年龄、高血糖、意识障碍、APACHEⅡ评分、血清白蛋白、穿刺部位、置管次数、留置时间均为BSI发生的影响因素。结论加强对老年患者重症加强监护病房血流感染危险因素的防范,并采取有效措施,可减少或避免BSI的发生。

Objective To study the risking factors of bloodstream infections （ BSI） of the elderly intensive care unit, so as to provide evidences for clinical practice. Methods Totally 384 elderly patients in intensive care unit between March 2014 and February 2016, were selected, and among them 89 patients were with the BSI. The risking factors of BSI were analysed retrospectively using. Results The BSI incidences of patients with the age ≥70 years old, hyperglycemia, unconsciousness,acute physiology and chronic health evaluation n （APACHE n ） score ≥17 points and serum albumin〈40g/L were 32. 02 % ,40. 96 % ,43. 33 % ,27. 31 % and 34. 67 % respectively,significantly higher than those with the age〈70 years old, no high blood sugar, unconscious barriers,APACHE Ⅱ〈17 and serum albumin ≥40g/L（15. 53 %, 18. 27 %, 17. 01 %, 17. 86% and 20. 13%） （P 〈0. 05）. Among 284 cases with venous catheters,the infection rates of those with femoral vein catheter,catheter indwelling time≥2 times and frequency≥7 d were 43.24% ,and 42. 19 %, significantly higher than those with the subclavian vein catheter, and retention time〈7d （27. 14 % ,20.29% and 18. 64%）. Logistic regression analysis showed that age, hyperglycemia, disturbance of consciousness, APACHE n score, serum albumin, the puncturing site,the times of catheter tubing and the needle indwelling time were the influencing factors of BSI. Conclusion Targeted measures against the risking factors can effectively prevent and reducebloodstream infection in the elderly intensive care unit.