烧伤患者医院感染危险因素的Meta分析

Meta-analysis of Risk Factors of Nosocomial Infection in Burn Patients

目的系统分析烧伤患者发生医院感染的危险因素。方法计算机检索中国期刊全文数据库(中国知网)、中文科技期刊数据库(维普)、中国学术期刊数据库(万方)、中国生物医学文献数据库(CBM)、PubMed、The Cochrane Library中2019年6月前公开发表的烧伤患者医院感染危险因素研究的文献,根据纳入与排除标准筛选符合标准的文献,采用纽卡斯尔-渥太华量表(NOS)对纳入文献进行质量评价,采用Rev Man 5.3软件对纳入文献进行统计分析。结果共纳入符合标准的文献13篇,包含烧伤患者12537例,发生医院感染者1577例,纳入危险因素12个,其中年龄(OR=2.47,95%CI为1.52~3.99)、烧伤程度(OR=3.99,95%CI为1.42~11.22)、烧伤面积(OR=13.45,95%CI为7.74~24.21)、吸入性损伤(OR=7.22,95%CI为4.08~12.78)、糖尿病(OR=1.49,95%CI为1.12~1.97)、预防性使用抗生素(OR=5.55,95%CI为2.81~10.96)、手术(OR=4.85,95%CI为1.71~13.79)、气管切开(OR=4.79,95%CI为2.19~10.49)、有创呼吸机的使用(OR=7.23,95%CI为5.04~10.38)、住院时间(OR=7.38,95%CI为2.68~20.33)是烧伤患者发生医院感染的危险因素。结论烧伤患者的一般情况、疾病情况及治疗情况均可影响烧伤患者医院感染的发生及发展,临床治疗中应正确识别烧伤感染高危人群,及时干预相关危险因素,以提高治疗效果。

Objective To systematically analyze the risk factors of nosocomial infection in burn patients.Methods Computer-based literature search was conducted to retrieve studies on risk factors of nosocomial infe ction in burn patients published before June 2019 in databases CNKI,VIP,Wanfang,CBM,PubMed,and the Cochrane Library.Based on the inclusion and exclusion criteria,the qualified study documents were screened out from the retrieved literature.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the study documents,and Rev Man 5.3 software was used for statistical analysis.Results A total of 13 papers were screened out from the retrieved literature,involving 12537 burn patients,of whom 1577 got nosocomial infection.A total of 12 risk factors were studied in the 13 papers,of which age(OR=2.47,95%Cl 1.52-3.99),burn degree(OR=3.99,95%CI 1.42-11.22),burned surface area(OR=13.45,95%CI 7.74-24.21),inhalation injury(OR=7.22,95%CI 4.08-12.78),diabetes mellitus(OR=1.49,95%CI1.12-1.97),prophylactic use of antibiotics(OR=5.55,95%CI 2.81-10.96),surgery(OR=4.85,95%CI 1.71-13.79),tracheotomy(OR=4.79,95%CI 2.19-10.49),use of invasive ventilator(OR=7.23,95%CI 5.04-10.38),and length of hospital stay(OR=7.38,95%CI 2.68-20.33)were the risk factors of nosocomial infection in burn patients.Conclusion The general condition,disease status and treatment all influence the occurrence and development of nosocomial infection in burn patients.In clinical practice,it is advisable to correctly identify the population at high risk of infection in burn patients and promptly manage the relevant risk factors,in order to improve the efficacy.