SICU重症腹腔细菌感染的危险因素分析

Analysis on the risk factors for severe abdominal infection in SICU patients

目的:了解外科重症监护病房(SICU)重症腹腔细菌感染的高危因素特点,以对合并有高危因素的腹腔疾病患者进行及时有效的抗感染治疗,降低病死率。方法:选取2014年1月1日至2015年12月31日因原发性腹腔疾病在广西医科大学第一附属医院及广西桂平市人民医院SICU治疗的138例患者,分析其感染致病菌的情况及药敏试验结果,采用多因素Logistic回归分析法及受试者工作特征(ROC)曲线评价诱发腹腔感染的危险因素。结果:共检出61株病原菌,其中细菌57株,占93.44%;真菌4株,占6.56%。共获得5个部位标本来源,其中29例腹腔引流液标本,占50.88%;其中12例胆汁标本,占21.05%;8例外周静脉血标本,占14.03%;6例中心静脉血标本,占10.53%;2例腹腔引流管末梢标本,占3.51%。急性生理与慢性健康评分(APACHEⅡ评分)、腹腔感染疾病部位、是否合并有腹部外伤及发生多器官功能障碍综合征(MODS)后其所累及的器官数量在发生与不发生腹腔细菌感染患者中所占比例比较,差异有统计学意义(P<0.05)。APACHEⅡ评分及发生MODS后其所累及的器官数量是发生腹腔细菌感染的独立危险因素(P<0.05);而发生MODS后其所累及的器官数量的ROC曲线下面积(AUC)最高,为0.909,准确性最高。结论:对于合并高危因素的腹腔疾病患者,应当警惕腹腔感染的发生并采取及时有效治疗策略。当严重腹腔感染发生时,如感染源不能彻底控制,多最终因多脏器功能衰竭导致治疗失败。清除感染源与防止多脏器功能衰竭是确保腹腔感染治疗成功的重要措施。

Objective： To analyze the risk factors for severe abdominal infection in order to take effective ear ly anti-infective therapy and reduce mortality. Methods： 138 patients with primary abdominal diseases in our hospital from January 1, 2014 to December 31, 2015 were selected. The results of drug sensitive test and infection pathogens were retrospectively analyzed. Multivariate logistic regression analysis and receiver operating characteristic （ROC） curve were used to assess the risk factors for abdominal infection. Results： 61 strains of pathogenic bacteria were isolated, with 57 strains of bacteria （93.44%） and 4 strains of fungi （6.56%）. The specimens were obtained from 5 sites including peritoneal fluid （50.88%）, bile （21.05%）, peripheral venous blood （14.03%）, central venous blood （10.53%） and abdominal drainage tube tip （3.51%）. APACHE Ⅱ score, the location of abdominal infection, the incidence of abdominal trauma and the number of organs involved in multiple organ dysfunction syndrome（MODS） were the risk factors for abdominal bacterial infection. Multivariate logistic regression analysis revealed that APACHE Ⅱ score and the number of organs involved in MODS were independent risk factors for abdominal bacterial infection （P 〈0.05）. The area under the ROC curve of involved organs number after MODS was the highest （AUC=0. 909）. Conclusion： The patients with abdominal diseases at high risk of abdominal infection should be given timely and effective therapy. Failed to control the source of infection would possibly result in multiple organ failure in severe abdominal infection patients.