重症康复单元昏迷患者再发肺部感染的危险因素

目的 分析重症康复单元昏迷患者再发肺部感染的影响因素。方法 回顾性分析2016年1月-2019年12月某院康复医学科重症康复单元住院治疗患者的临床资料，比较入住康复科后再发肺部感染组和非肺部感染组患者的基本情况、受伤形式、基础疾病、实验室检查及康复干预措施等。结果 共调查269例患者，再发肺部感染167例。logistics回归分析显示，低血清清蛋白（95%CI：0.750~0.883，OR=0.814）、GCS<8分（95%CI：0.176~0.571，OR=0.317）及昏迷时间≥ 3周（95%CI：1.637~10.752，OR=4.196）是昏迷患者再发肺部感染的独立危险因素。269例患者共检出245株病原菌，居前三位依次为铜绿假单胞菌（77株，31.43%）、鲍曼不动杆菌（70株，28.57%）、肺炎克雷伯菌（40株，16.32%）；多重耐药菌主要为鲍曼不动杆菌（63株，49.22%）、铜绿假单胞菌（29株，22.66%）、肺炎克雷伯菌（20株，15.62%）。结论 对于重症康复单元昏迷患者，积极改善意识水平，纠正及预防低白蛋白血症以及尽可能缩短住院时间有利于降低其肺部感染发病率。

Risk factors for recurrent pulmonary infection in coma patients in the intensive rehabilitation care unit

Objective To analyze the influencing factors for recurrent pulmonary infection in coma patients in intensive rehabilitation unit. Methods Clinical data of hospitalized patients in the intensive rehabilitation unit of rehabilitation medicine department of a hospital from January 2016 to December 2019 were retrospectively analyzed, basic condition, injury, underlying diseases, laboratory tests and rehabilitation intervention were compared between patients in recurrent pulmonary infection group and non-pulmonary infection group in the rehabilitation department. Results A total of 269 patients were investigated, and 167 cases had recurrent pulmonary infection. Logistic regression analysis showed that low serum albumin (95%CI:0.750-0.883, OR=0.814), GCS<8 (95%CI:0.176-0.571, OR=0.317) and coma time ≥ 3 weeks (95%CI:1.637-10.752, OR=4.196) were independent risk factors for recurrent pulmonary infection in coma patients. A total of 245 pathogens were isolated from 269 patients, the top three were Pseudomonas aeruginosa (77 strains, 31.43%), Acinetobacter baumannii (70 strains, 28.57%), and Klebsiella pneumoniae (40 strains, 16.32%); the main multidrug-resistant organisms were Acinetobacter baumannii (63 strains, 49.22%), Pseudomonas aeruginosa (29 strains, 22.66%), and Klebsiella pneumoniae (20 strains, 15.62%). Conclusion For coma patients in intensive rehabilitation unit, improving their consciousness, correcting and preventing hypoalbuminemia and shortening hospital stay as far as possible are conducive to reducing the incidence of pulmonary infection.