作者：高学民，苑振飞，李晓云，李卓隽

单位：

063000 河北省唐山市协和医院 ICU；通信作者：高学民，E-mail：gxmfff@126.com

Units：

ICU，Xiehe Hospital of Tangshan，Tangshan 063000，China；Corresponding author：GAO Xuemin，E-mail：gxmfff@126.com

关键词：

卒中；败血症；重症监护病房；病原菌；影响因素分析

Keywords：

Stroke；Septicemia；Intensive care unit；Pathogenic bacteria；Root cause analysis

CLC：

R 743　R 631.3

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.013

Funds：

摘要：

背景　15%~25% 的急性缺血性脑卒中（AIS）患者死于细菌性肺炎，其中约 5% 出现败血症，但 ICU中 AIS 患者败血症的影响因素尚不明确。目的　分析 ICU 中 AIS 患者败血症发生情况及其影响因素。方法　选取 2015年 3 月—2019 年 3 月唐山市协和医院 ICU 收治的 AIS 患者 364 例，回顾性分析其败血症发生情况及病原菌，分析 ICU中 AIS 患者发生败血症的影响因素采用单因素分析及多因素 Logistic 回归分析。结果　（1）364 例 AIS 患者中 225例发生败血症，发生率为 61.8%；225 例败血症患者病原菌主要为肺炎克雷伯菌（占 26.22%）、铜绿假单胞菌（占19.11%）、金黄色葡萄球菌（占 16.44%）、鲍曼不动杆菌（占 13.33%）。（2）不同年龄、性别、病灶部位及有无高血压、吸烟史患者败血症发生率比较，差异无统计学意义（P>0.05）；有无意识障碍、侵入性操作、糖尿病、营养不良、慢性阻塞性肺疾病（COPD）及是否预防性应用抗生素、使用糖皮质激素患者败血症发生率比较，差异有统计学意义（P<0.05）。发生败血症患者入院时急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷量表（GCS）评分高于未发生败血症患者（P<0.05）。（3）多因素 Logistic 回归分析结果显示，意识障碍〔OR=9.526，95%CI（1.321，68.695）〕、侵入性操作〔OR=2.784，95%CI（1.484，5.223）〕、 糖 尿 病〔OR=12.604，95%CI（1.006，157.969）〕、 营 养 不 良〔OR=3.536，95%CI（1.171，10.681）〕、COPD〔OR=7.569，95%CI（1.351，42.387）〕、预防性应用抗生素〔OR=3.459，95%CI（1.483，8.067）〕、入院时 APACHE Ⅱ评分〔OR=9.718，95%CI（1.466，64.418）〕、入院时 NIHSS 评分〔OR=5.228，95%CI（1.214，22.515）〕、入院时GCS评分〔OR=3.873，95%CI （2.354，6.372）〕是ICU中AIS患者发生败血症的独立影响因素（P<0.05）。结论　ICU 中 AIS 患者败血症发生率较高，为 61.8%；意识障碍、侵入性操作、糖尿病、营养不良、COPD、预防性应用抗生素及入院时 APACHE Ⅱ评分、NIHSS 评分、GCS 评分升高是 ICU 中 AIS 患者发生败血症的危险因素。

Abstract：

Background　In patients with acute ischemic stroke（AIS），15% to 25% patients died due to bacterialpneumonia，thereinto about 5% patients complicated with septicemia，however influencing factors of septicemia in patientswith AIS in ICU are not yet clear. Objective　To analyze the occurrence and influencing factors of septicemia in patientswith AIS in ICU. Methods　From March 2015 to March 2019，a total of 364 patients with AIS were selected in ICU，XieheHospital of Tangshan，the incidence of septicemia and pathogenic bacteria were retrospectively analyzed，moreover influencingfactors of septicemia in patients with AIS in ICU were analyzed by univariate analysis and multivariate Logistic regressionanalysis. Results　（1）Of the 364 patients with AIS in ICU，225 cases occurred septicemia，with an incidence of 61.8%；of the 225 patients complicated with septicemia，pathogenic bacteria mainly involved Klebsiella pneumoniae（accountingfor 26.22%），Pseudomonas aeruginosa（accounting for 19.11%），Staphylococcus aureus（accounting for 16.44%），Acinetobacter baumannii（accounting for 13.33%）.（2）There was no statistically significant difference in incidence ofsepticemia in patients with different age，gender or nidus，as well as with hypertension or smoking history or not（P>0.05），while there were statistically significant difference in incidence of septicemia in patients with consciousness disorder，invasive operation，diabetes，malnutrition，COPD or not，as well as using prophylactic antibiotics and glucocorticoids ornot（P<0.05）. APACHE Ⅱ score，NIHSS score and GCS score at admission in patients complicated with septicemia werestatistically significantly higher than those in patients did not complicated with septicemia（P<0.05）.（3）MultivariateLogistic regression analysis results showed that，consciousness disorder〔OR=9.526，95%CI（1.321，68.695）〕，invasiveoperation〔OR=2.784，95%CI（1.484，5.223）〕，diabetes〔OR=12.604，95%CI（1.006，157.969）〕，malnutrition〔OR=3.536，95%CI（1.171，10.681）〕，COPD〔OR=7.569，95%CI（1.351，42.387）〕，using of prophylacticantibiotics〔OR=3.459，95%CI（1.483，8.067）〕，APACHE Ⅱ score at admission 〔OR=9.718，95%CI（1.466，64.418）〕，NIHSS score at admission〔OR=5.228，95%CI（1.214，22.515）〕and GCS score at admission〔OR=3.873，95%CI（2.354，6.372）〕were independent influencing factors of septicemia in patients with AIS in ICU（P<0.05）.Conclusion　Risk of septicemia is relatively high in patients with AIS in ICU，with an incidence of 61.8%；consciousnessdisorder，invasive operation，diabetes，malnutrition，COPD，using of prophylactic antibiotics，as well as high APACHE Ⅱscore，NIHSS score and GCS score at admission are independent risk factors of septicemia in patients with AIS in ICU.

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