目的:探讨重症监护病房（ICU）内血流感染（BSI）患者预后的危险因素，为危重BSI患者的早预警、早治疗提供参考。方法:回顾性分析2019年1月1日至9月30日入住贵州医科大学附属医院重症医学科内所有血培养阳性患者的临床资料。收集患者的性别、年龄、基础疾病比例、确诊BSI当日急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）、BSI后机械通气时间、ICU住院时间、BSI后侵袭性操作和血液制品输注情况、BSI后实施连续性肾脏替代治疗（CRRT）比例、BSI后连续使用血管活性药物≥72 h比例、中心静脉置管部位、诊断为BSI后72 h内实验室指标最差值以及病原微生物资料，分析病原体分布情况，根据28 d预后情况分为死亡组及存活组，比较两组间临床资料差异。采用Logistic回归分析筛选影响BSI患者预后的独立危险因素。结果:共纳入154例BSI阳性患者，检出菌株156株，其中革兰阳性（Gn +）菌75株，革兰阴性（Gn -）菌70株，真菌11株，其中排列前5位的病原微生物分别为凝固酶阴性葡萄球菌（占35.9%）、肺炎克雷伯杆菌（占12.8%）、鲍曼不动杆菌（占9.0%）、肠球菌（占9.0%）、大肠埃希菌（占8.3%）。此外，Gn +菌中共出现45株多重耐药菌株（占60.0%），Gn -菌出现40株多重耐药菌株（占57.1%），真菌出现1株多重耐药株（占9.1%）。根据28 d临床结局分组后，存活组81例，死亡组73例。存活组和死亡组间年龄、ICU住院时间、BSI后机械通气时间、合并慢性阻塞性肺疾病（COPD）、高血压、心血管疾病及慢性肾功能不全基础疾病比例差异均无统计学意义（均n P>0.05）。死亡组男性比例明显低于存活组〔58.9%（43/73）比75.3%（61/81），n P<0.05〕，APACHEⅡ评分明显高于存活组（分：27.1±7.0比19.5±6.7，n P<0.05）；死亡组患者BSI后前3 d平均动脉压（MAP）较存活组明显降低〔mmHg（1 mmHg＝0.133 kPa）：72.8±13.6比79.7±12.9，n P<0.05〕，死亡组患者合并糖尿病、恶性肿瘤比例〔28.8%（21/73）比12.3%（10/81），19.2%（14/73）比7.4%（6/81）〕、BSI后CRRT以及输血比例〔39.7%（29/73）比16.0%（13/81），64.4%（47/73）比46.9%（38/81）〕、连续使用血管活性药物时间≥72 h比例〔37.0%（27/73）比12.3%（10/81）〕均较存活组明显升高（均n P<0.05）。死亡组血小板计数（PLT）较存活组明显降低（×10n 9/L：124.93±98.21比181.15±116.39，n P<0.05），天冬氨酸转氨酶（AST）水平较存活组明显升高〔U/L：75.40（38.50，140.95）比56.20（29.20，85.70），n P0.05）。Logistic回归分析结果显示，APACHEⅡ评分〔优势比（n OR）＝1.279，95%可信区间（95%n CI）为1.158～1.412，n P 0.05). In death group, the proportion of male was obviously lower than that of survival group [58.9% (43/73) vs. 75.3% (61/81), n P < 0.05] and APACHE Ⅱ score was significantly higher than that in survival group (27.1±7.0 vs. 19.5±6.7, n P < 0.05). The mean arterial pressure (MAP) of death group on first 3 days of BSI was significantly lower than that of survival group [mmHg (1 mmHg = 0.133 kPa): 72.8±13.6 vs. 79.7±12.9, n P < 0.05), in the death group, the proportion of patients complicated with diabetes, cancer [28.8% (29/73) vs. 12.3% (10/81), 19.2% (14/73) vs. 7.4% (6/81)], post-BSI CRRT and blood transfusion [39.7% (29/73) vs. 16.0% (13/81), 64.4% (47/73) vs. 46.9% (38/81)], and continuous use of asoactie drugs for≥72 hours [37.0% (27/73) vs. 12.3% (10/81)] were significantly higher than those in the survival group (all n P < 0.05). In death group, platelet count (PLT) was significantly decreased than that of survival group [×10 n 9/L: 124.93±98.21 vs. 181.15±116.39, n P < 0.05], aspartate aminotransferase (AST) level was significantly higher than that of survival group [U/L: 75.40 (38.50, 140.95) vs. 56.20 (29.20, 85.70), n P 0.05). The results of Logistic regression analysis showed that the APACHEⅡ score [odds ratio ( n OR) = 1.279, 95% confidence interval (95%n CI) was 1.158 to 1.412, n P < 0.001], CRRT after BSI ( n OR = 3.522, 95%n CI was 1.013 to 12.245, n P = 0.048) were independent risk factors affecting the prognosis of patients with BSI, and MAP is a protective factor for prognosis (n OR = 0.961, 95%n CI was 0.927 to 0.996, n P = 0.031).n Conclusions:In our ICU, Gn + bacteria are still dominant in bloodstream infection, Gn - bacteria take the second place. Besides, APACHE Ⅱ score and CRRT after being diagnosed with BSI are the independent prognostic risk factors.n