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目的铜绿假单胞菌逐渐成为院内感染的主要菌株,且耐药性较高。本文旨在探讨机械通气的严重胸外伤患者铜绿假单胞菌感染的流行病学和危险因素,为临床上防治机械通气相关性铜绿假单胞菌感染提供依据。方法前瞻性收集2012年1月—2016年1月温州医科大学附属第五医院收治的机械通气的严重胸外伤患者218例,主要观察指标为铜绿假单胞菌感染的流行病学和危险因素,次要观察指标为铜绿假单胞菌的耐药性。结果共21例(9.63%)患者发生铜绿假单胞菌感染,在机械通气后3~47 d确诊,平均在机械通气后(19.57±7.38)d确诊为铜绿假单胞菌感染。与对照组比较,研究组患者机械通气时间显著延长、开放性损伤率、APACHEⅡ评分、抗菌素使用种类≥3种率、开胸手术率、血气胸发生率和多发伤率显著增高(P<0.05)。单因素和多因素回归分析显示机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素(P<0.05)。21株铜绿假单胞菌中,18例为多重耐药菌,2例为泛耐药菌,对亚胺培南和美罗培南耐药率较低(14.29%)。结论机械通气的严重胸外伤患者铜绿假单胞菌感染率和耐药性较高,机械通气时间、APACHEⅡ评分和开胸手术是机械通气的严重胸外伤患者铜绿假单胞菌感染的危险因素,对这类患者加强铜绿假单胞菌的防治或可改善临床预后。
Pseudomonas aeruginosa has gradually become the main strain of nosocomial infection and its drug resistance is high. This article aims to investigate the epidemiological and risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma with mechanical ventilation, and to provide evidence for the prevention and treatment of mechanical ventilation-associated Pseudomonas aeruginosa infection clinically. Methods Prospectively collected 218 cases of severe thoracic trauma with mechanical ventilation admitted to the Fifth Affiliated Hospital of Wenzhou Medical University from January 2012 to January 2016. The main observation indicators were the epidemiological and risk factors of Pseudomonas aeruginosa infection, Secondary observation was P. aeruginosa resistance. Results A total of 21 patients (9.63%) had Pseudomonas aeruginosa infection and were diagnosed 3 ~ 47 days after mechanical ventilation. The mean Pseudomonas aeruginosa infection was confirmed after mechanical ventilation (19.57 ± 7.38) days. Compared with the control group, the study group had a significantly longer duration of mechanical ventilation. The open injury rate, APACHEⅡscore, antibiotic use≥3, thoracotomy rate, hemothorax incidence and multiple trauma were significantly higher (P <0.05) . Univariate and multivariate regression analysis showed that the duration of mechanical ventilation, APACHEⅡscore and thoracotomy were the risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma with mechanical ventilation (P <0.05). Of the 21 strains of Pseudomonas aeruginosa, 18 were multidrug-resistant and 2 were pan-resistant, with a low resistance rate to imipenem and meropenem (14.29%). Conclusion The prevalence of Pseudomonas aeruginosa infection and drug resistance in patients with severe thoracic trauma with mechanical ventilation is high. The duration of mechanical ventilation, APACHEⅡscore and thoracotomy were the risk factors of Pseudomonas aeruginosa infection in patients with severe thoracic trauma with mechanical ventilation. To strengthen the prevention and treatment of Pseudomonas aeruginosa in such patients or to improve the clinical prognosis.