發(fā)布時間：2018-03-08 08:55

  本文選題：血流感染　切入點：死亡　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:1.探討糖尿病重癥患者死亡及發(fā)生血流感染的風險因素2.分析糖尿病重癥患者主要革蘭陰性桿菌分布及耐藥性。方法:1.收集我院2014年6月至2016年5月入住ICU重癥病例105例。納入標準:行有創(chuàng)機械通氣時間≥48小時,住院時間≥72小時。比較糖尿病重癥患者與非糖尿病重癥患者死亡之間的關(guān)系,分析ICU重癥患者死亡的風險因素。比較糖尿病重癥患者與非糖尿病重癥患者發(fā)生血流感染之間的關(guān)系,分析ICU重癥患者發(fā)生血流感染的風險因素。2.分析我院ICU 2015年1月至2017年1月2年期間危重患者的革蘭氏陰性桿菌的分布和耐藥情況。結(jié)果:1.與ICU非糖尿病危重病人死亡率相比,糖尿病危重病人死亡率高(χ2=4.57 P0.05)�？梢娞悄虿∈荌CU危重患者死亡的危險因素之一。年齡、APACHE II評分、高血壓、心血管疾病、慢性腎臟疾病、腸外營養(yǎng)、膿毒血癥均是危重病人死亡的危險因素,差異有統(tǒng)計學意義(P0.05)。在多變量分析中,ICU危重病人死亡的獨立風險因素是膿毒血癥和腸外營養(yǎng)。與ICU非糖尿病危重病人血流感染發(fā)生率相比,糖尿病危重病人血流感染發(fā)生率高(χ2=3.94 P0.05)�？梢娞悄虿⊥瑫r也是ICU危重病人發(fā)生血流感染的風險因素。年齡、BMI、APACHEⅡ評分、性別、糖尿病病程、Hb A1C≥7%、心血管疾病、腦卒中、慢性腎臟疾病、既往血流感染史、高血壓均是危重病人發(fā)生血流感染的危險因素,差異無統(tǒng)計學意義(P0.05)。在單變量分析中,糖尿病、腦卒中、既往血流感染史比較差異有統(tǒng)計學意義(P0.05)。在多變量分析中,ICU危重病人發(fā)生血流感染的獨立危險因素是腦卒中和既往血流感染史。2.收集本院2015年1月至2017年1月入住ICU重癥病人分離出的革蘭氏陰性桿菌213株,其中糖尿病重癥患者74株,非糖尿病重癥患者139株,好發(fā)于呼吸系統(tǒng)、泌尿系統(tǒng)、血液、胸腹腔積液等。主要致病菌依次為銅綠假單胞菌55株(25.82%),糖尿病重癥患者15株,非糖尿病重癥患者40株;肺炎克雷伯菌53株(24.88%),糖尿病重癥患者26株,非糖尿病重癥患者27株;鮑曼不動桿菌40株(18.78%),糖尿病重癥患者15株,非糖尿病重癥患者25株;大腸埃希桿菌23株(10.80%),糖尿病重癥患者6株,非糖尿病重癥患者17株。黏質(zhì)沙雷菌10株(4.69%)糖尿病重癥患者2株,非糖尿病重癥患者8株;奇異變形菌7株(3.29%),糖尿病重癥患者2株,非糖尿病重癥患者5株;嗜麥芽窄食單胞菌7株(3.29%),糖尿病重癥患者0株,非糖尿病重癥患者7株;陰溝腸桿菌5株(2.34%),糖尿病重癥患者3株,非糖尿病重癥患者2株。其中多重耐藥菌多見,共計51株(23.94%),此次研究2年來糖尿病患者組與非糖尿病患者組多重耐藥率比較無統(tǒng)計學意義(χ2=2.53 P0.05)。比較亞胺培南和美羅培南的耐藥率,銅綠假單胞菌分別為38.18%和21.82%,肺炎克雷伯菌分別為1.89%和26.42%,鮑曼不動桿菌分別為52.5%和95%。嗜麥芽窄食單胞菌雖對碳青霉烯類耐藥率100%,但對復方磺胺甲VA唑和米諾環(huán)素的敏感率可以高達90%。結(jié)論:1.糖尿病是ICU重癥患者死亡和發(fā)生血流感染的風險因素之一。ICU重癥患者死亡的獨立風險因素是膿毒血癥和腸外營養(yǎng)。ICU重癥患者發(fā)生血流感染的獨立風險因素是腦卒中和血流感染史。2.控制糖尿病患者多重耐藥革蘭氏陰性桿菌感染非常重要,激勵我們堅持或改善合理的抗生素治療的原則,遵守合理的抗生素策略的原則為了保持細菌對至少那些仍然有效的抗生素的敏感性并且減緩抗生素抗性的增加而努力。
[Abstract]:Objective: To investigate 1. patients with diabetes mellitus and death risk factors of bloodstream infections in 2. patients with severe diabetes: analysis of main leather Distribution and drug resistance of gram negative bacillus. Methods: 1. cases were collected from June 2014 to May 2016 in our hospital 105 cases of severe ICU. Inclusion criteria: 48 hours for invasive mechanical ventilation over time, hospitalization time more than 72 hours comparison of the relationship between death in patients with severe diabetes and non diabetes patients, risk factors of mortality in patients with severe ICU. The relationship between the bloodstream infection of diabetic and non diabetic patients with severe occurrence of severe cases, analysis of risk factors of bloodstream infection occurred in patients with severe ICU.2. ICU in our hospital from January 2015 to January 2017 analysis of distribution and drug resistance during 2 years critically ill patients with Gram negative bacilli. Results: 1. ICU and mortality in patients with diabetes compared with non severe diabetes, critical illness People with high mortality (2=4.57 P0.05). The diabetes is one of the risk factors of death of ICU patients. Age, APACHE II score, hypertension, cardiovascular disease, chronic kidney disease, parenteral nutrition, sepsis were risk factors of death in critically ill patients, the difference was statistically significant (P0.05). In the multivariate analysis ICU, independent risk factors of death in critically ill patients is sepsis and parenteral nutrition. The incidence rate of blood flow in ICU patients compared with non diabetes infection, incidence of high blood flow in patients with diabetic severe infection (2=3.94 P0.05). See the risk factors of bloodstream infection in critically ill patients. Diabetes is also ICU age, BMI, APACHE II score, gender, duration of diabetes, Hb A1C = 7%, cardiovascular disease, stroke, chronic kidney disease, previous history of blood infections, hypertension are risk factors for bloodstream infection in critically ill patients, no difference Statistical significance (P0.05). In univariate analysis, diabetes, stroke, there was a significant difference between the history of bloodstream infections (P0.05). In multivariate analysis, ICU critically ill patients of independent risk factors for bloodstream infection is stroke and blood infections past history of.2. of our hospital from January 2015 to January 2017 ICU patients with isolated 213 strains of gram negative bacilli, 74 strains of diabetic patients with severe non diabetes patients, 139 strains occur in the respiratory system, urinary system, blood, ascites and pleural effusion. The main pathogenic bacteria in Pseudomonas aeruginosa 55 strains (25.82%), 15 diabetic patients with severe strains. Non diabetic patients with severe 40 strains; 53 strains of Klebsiella pneumoniae (24.88%), diabetic patients with severe non diabetes patients with 26 strains, 27 strains of Bauman Acinetobacter; 40 strains (18.78%), diabetic patients ofcritically 15 strains of non diabetic patients with severe 25 Strains of Escherichia coli; 23 strains (10.80%), diabetic patients with severe non diabetes patients with 6 strains, 17 strains of Serratia marcescens. 10 strains (4.69%) of patients with diabetes in 2 strains, 8 strains of non diabetic patients; Proteus mirabilis 7 strains (3.29%), 2 diabetic patients with severe non diabetic patients with severe strains. 5 strains; Stenotrophomonas maltophilia 7 strains (3.29%), 0 diabetic patients with severe non diabetic patients with severe strains, 7 strains; 5 strains of Enterobacter cloacae (2.34%), 3 diabetic patients with severe non diabetic patients with severe strains, 2 strains of multidrug-resistant bacteria. The more common, a total of 51 strains (23.94% the study of 2 years), patients with diabetes and non diabetes patients with multi drug resistant rate was not statistically significant (2=2.53 P0.05). The resistance rate of imipenem and meropenem imipenem and Pseudomonas aeruginosa were 38.18% and 21.82%, Klebsiella pneumoniae were 1.89% and 26.42% respectively, Bauman Acinetobacter 52.5% and 95%. stenotrophomonasmaltophilia although the carbapenem resistance rate of 100%, but the sensitivity rate to VA triazole compound sulfamethoxazole and minocycline can be as high as 90%. conclusion: 1. ICU patients with severe diabetes is an independent risk factor for the occurrence and death of death risk factors of.ICU in patients with severe sepsis is bloodstream infection toxemia and parenteral nutrition in patients with severe.ICU independent risk factors for bloodstream infection is the history of.2. control of diabetes mellitus patients with multi drug resistant gram negative bacillus infection is very important infection of stroke and blood flow, we adhere to the incentive or improve the reasonable antibiotic treatment principle, abide by the reasonable strategy in order to maintain the principle of antibiotic bacteria to increase at least those who are still effective antibiotic sensitivity and reduce antibiotic resistance.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1;R459.7

【參考文獻】

相關(guān)期刊論文 前5條

1 吳先榮;;重癥醫(yī)學科325株革蘭氏陰性桿菌的耐藥性分析[J];中國實用醫(yī)藥;2014年09期

2 江穩(wěn)強;方明;陳純波;王橋生;葉珩;曾紅科;;膿毒癥患者應激性高血糖與免疫功能變化及預后的關(guān)系[J];中國病理生理雜志;2009年04期

3 王連偉;汪建民;張大鵬;李萬森;王想;;糖尿病并發(fā)感染患者免疫功能改變及相關(guān)因素分析[J];醫(yī)藥論壇雜志;2008年20期

4 許媛;;重癥病人的血糖控制[J];外科理論與實踐;2008年03期

5 朱燦宏,莊志,戴抒紅;腦卒中患者醫(yī)院獲得性肺炎的相關(guān)危險因素分析[J];中國感染控制雜志;2003年03期

，

本文編號：1583213