ICU中急性缺血性脑卒中患者败血症发生情况及其影响因素研究

背景 15%~25%的急性缺血性脑卒中(AIS)患者死于细菌性肺炎,其中约5%出现败血症,但ICU中AIS患者败血症的影响因素尚不明确。目的分析ICU中AIS患者败血症发生情况及其影响因素。方法选取2015年3月-2019年3月唐山市协和医院ICU收治的AIS患者364例,回顾性分析其败血症发生情况及病原菌,分析ICU中AIS患者发生败血症的影响因素采用单因素分析及多因素Logistic回归分析。结果 (1) 364例AIS患者中225例发生败血症,发生率为61.8%;225例败血症患者病原菌主要为肺炎克雷伯菌(占26.22%)、铜绿假单胞菌(占19.11%)、金黄色葡萄球菌(占16.44%)、鲍曼不动杆菌(占13.33%)。(2)不同年龄、性别、病灶部位及有无高血压、吸烟史患者败血症发生率比较,差异无统计学意义(P>0.05);有无意识障碍、侵入性操作、糖尿病、营养不良、慢性阻塞性肺疾病(COPD)及是否预防性应用抗生素、使用糖皮质激素患者败血症发生率比较,差异有统计学意义(P<0.05)。发生败血症患者入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分高于未发生败血症患者(P<0.05)。(3)多因素Logistic回归分析结果显示,意识障碍OR=9.526,95%CI(1.321,68.695)]、侵入性操作OR=2.784,95%CI(1.484,5.223)]、糖尿病OR=12.604,95%CI(1.006,157.969)]、营养不良OR=3.536,95%CI(1.171,10.681)]、COPDOR=7.569,95%CI(1.351,42.387)]、预防性应用抗生素OR=3.459,95%CI(1.483,8.067)]、入院时APACHEⅡ评分OR=9.718,95%CI(1.466,64.418)]、入院时NIHSS评分OR=5.228,95%CI(1.214,22.515)]、入院时GCS评分OR=3.873,95%CI(2.354,6.372)]是ICU中AIS患者发生败血症的独立影响因素(P<0.05)。结论 ICU中AIS患者败血症发生率较高,为61.8%;意识障碍、侵入性操作、糖尿病、营养不良、COPD、预防性应用抗生素及入院时APACHEⅡ评分、NIHSS评分、GCS评分升高是ICU中AIS患者发生败血症的危险因素。

Occurrence and Influencing Factors of Septicemia in Patients with Acute Ischemic Stroke in ICU

Background In patients with acute ischemic stroke(AIS),15% to 25% patients died due to bacterial pneumonia,thereinto about 5% patients complicated with septicemia,however influencing factors of septicemia in patients with AIS in ICU are not yet clear. Objective To analyze the occurrence and influencing factors of septicemia in patients with AIS in ICU. Methods From March 2015 to March 2019,a total of 364 patients with AIS were selected in ICU,Xiehe Hospital of Tangshan,the incidence of septicemia and pathogenic bacteria were retrospectively analyzed,moreover influencing factors of septicemia in patients with AIS in ICU were analyzed by univariate analysis and multivariate Logistic regression analysis. Results(1)Of the 364 patients with AIS in ICU,225 cases occurred septicemia,with an incidence of 61.8%;of the 225 patients complicated with septicemia,pathogenic bacteria mainly involved Klebsiella pneumoniae(accounting for 26.22%),Pseudomonas aeruginosa(accounting for 19.11%),Staphylococcus aureus(accounting for 16.44%),Acinetobacter baumannii(accounting for 13.33%).(2)There was no statistically significant difference in incidence of septicemia in patients with different age,gender or nidus,as well as with hypertension or smoking history or not(P>0.05),while there were statistically significant difference in incidence of septicemia in patients with consciousness disorder,invasive operation,diabetes,malnutrition,COPD or not,as well as using prophylactic antibiotics and glucocorticoids or not(P<0.05). APACHE Ⅱ score,NIHSS score and GCS score at admission in patients complicated with septicemia were statistically significantly higher than those in patients did not complicated with septicemia(P<0.05).(3)Multivariate Logistic regression analysis results showed that,consciousness disorderOR=9.526,95%CI(1.321,68.695)],invasive operationOR=2.784,95%CI(1.484,5.223)],diabetesOR=12.604,95%CI(1.006,157.969)],malnutritionOR=3.536,95%CI(1.171,10.681)],COPDOR=7.569,95%CI(1.351,42.387)],using of prophylactic antibioticsOR=3.459,95%CI(1.483,8.067)],APACHE Ⅱ score at admission OR=9.718,95%CI(1.466,64.418)],NIHSS score at admissionOR=5.228,95%CI(1.214,22.515)]and GCS score at admissionOR=3.873,95%CI(2.354,6.372)]were independent influencing factors of septicemia in patients with AIS in ICU(P<0.05). Conclusion Risk of septicemia is relatively high in patients with AIS in ICU,with an incidence of 61.8%;consciousness disorder,invasive operation,diabetes,malnutrition,COPD,using of prophylactic antibiotics,as well as high APACHE Ⅱ score,NIHSS score and GCS score at admission are independent risk factors of septicemia in patients with AIS in ICU.