ICU鲍氏不动杆菌肺炎预后及危险因素研究.docVIP

ICU鲍氏不动杆菌肺炎预后及危险因素研究[摘要] 目的:探讨ICU鲍氏不动杆菌肺炎患者预后及危险因素。方法:2007年6月1日至2008年5月?31日入住东南大学附属中大医院ICU的鲍氏不动杆菌肺炎患者纳入观察,记录患者一般情况、抗生素的使用和病原菌药敏结果等,并记录患者28 d病死率及60 d病死率等临床指标,对可能影响鲍氏不动杆菌肺炎患者预后的危险因素进行分析。结果:观察期内入中大医院ICU的426例患者中医院获得性鲍氏不动杆菌肺炎患者52例,鲍氏不动杆菌肺炎发生率为12.2%。患者28 d病死率为32.7%,60 d病死率为34.6%。生存组患者确诊鲍氏不动杆菌肺炎时GCS评分和平均动脉压均明显高于死亡组,而确诊前合并真菌感染及病程中发生休克的比例均明显低于死亡组。Logistic多元回归分析结果显示确诊鲍氏不动杆菌肺炎时GCS评分低,确诊前合并真菌感染以及病程中发生休克是鲍氏不动杆菌肺炎患者死亡的独立危险因素。结论:ICU鲍氏不动杆菌肺炎患者确诊前合并真菌感染以及病程中发生休克提示患者预后不良。? [关键词] 鲍曼不动杆菌; 肺炎; 预后? [中图分类号] R563.1[文献标识码] A[文章编号] 1671-7562(2010)01-0006-05? doi:10.3969/j.issn.1671-7562.2010.01.002?? Prognosis and risk factor of patients with pneumonia caused ? by Acinetobacter baumannii in ICU?? LI Jia, LIU Ling, YANG Yi (Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, China)?? [Abstract] Objective: To investigate the prognosis and risk factor of the patients with pneumoniacaused by Acinetobacter baumannii in ICU. Methods: Fifty-two patients with pneumonia caused by Acinetobacter baumannii from June in 2007 to May in 2008 were enrolled in this study and were divided into two groups based on the prognosis. The following parameters of the patients were recorded: baseline characteristics of patients, the use of antibiotic, the sensitivity of Acinetobacter baumannii, 28-day mortality and 60-day mortality. Results: Fifty-two patients met the criteria for pneumoniacaused by Acinetobacter baumannii in the total 426 patients. The incidence of pneumoniacaused by Acinetobacter baumannii in this study was 12.2%, the 28-day mortality was 32.7% and the 60-day mortality was 34.6%. GCS score and MAP at enrollment of survivals were much higher than nonsurvivals, and the rates of superinfection by fungi before enrollment and shock during the course of disease were much lower. With the multivariate analysis, a lower GCS score at enrollment, superinfection by fungi before enrollment and a higher shock rate were independent risk factors of t