重症感染降阶梯治疗失败的相关性研究

目的:对重症感染患者降阶梯治疗失败的危险因素进行研究,为合理进行降阶梯治疗提供科学依据。方法:以某院2007年1月-2014年12月412例采用降阶梯治疗重症感染患者为调查对象,由医院信息管理系统导出所需的各项调查项目,再采用Excel统一填写各项调查项目,对412例调查项目齐全的病例进行研究,数据采用SPSS 13.0统计软件进行分析,各变量现经单因素分析后,选择具有统计学差异的因素再进行非条件Logistic回归分析。结果:高龄(≥70岁)、多重耐药菌感染、低蛋白血症(<30 g)、呼吸机辅助呼吸时间过长(≥7 d)为降阶梯治疗失败的危险因素,其中高龄(≥70岁)、多重耐药菌感染、低蛋白血症(<30 g)为降阶梯治疗失败的独立危险因素。结论:重症感染的患者如存在高龄(≥70岁)、多重耐药菌感染、低蛋白血症(<30 g)因素,则尽量不要采用降阶梯治疗。如果同时存在高龄(≥70岁)和多重耐药菌感染或高龄(≥70岁)和低蛋白血症(<30 g)的重症感染患者不能采用降阶梯治疗法。

Correlation between failed therapy against severe infection and de-escalation therapy

OBJECTIVE To study risk factors of failed therapy against severe infection in patients. METHODS From January 2007 to December 2014, 412 cases of patients with severe infection treated by using de-escalation therapy were enrolled. Survey data were summarized by using hospital information system, and filled uniformly by using Excel. Data of 412 patients were analyzed by using SPSS 13 software. After single factor analysis, factors with statistical significance were processed by using non conditional Logistic regression analysis. RESULTS Old age(≥70 years), multi drug resistant bacteria infection, hypoproteinemia(<30 g), long duration of ventilator assisted ventilation(≥7 days) were risk factors for failure of de-escalation therapy. Old age(≥70 years), multi drug resistant bacteria infection and hypoproteinemia(<30 g) were independent risk factors. CONCLUSION De-escalation therapy is not recommended for severe infection patients with risk factors including old age(≥70 years old), multi drug resistant bacteria infection or hypoproteinemia(< 30 g) factors.