重症监护病房创伤患者并发医院感染多因素探讨

目的：探讨导致重症监护病房（ ICU）内创伤患者医院感染发生的危险因素，为临床防治提供参考。方法回顾性分析983例在ICU创伤患者的临床资料，按是否感染分为感染组及未感染组，对年龄等潜在危险因素的单因素分析，并依据创伤严重程度ISS评分将感染组分为轻度创伤（ ISS＜16分）及严重创伤（ ISS≥16分）患者，分别对单因素分析结果实施所有感染患者及严重创伤感染患者的多因素分析，得出相应的独立危险因素。结果983例患者发生医院感染的独立危险因素有年龄≥60岁（OR＝1．70，95％CI 1．05～2．69）、ICU治疗时间≥2周（OR＝1．59，95％CI 1．06～2．49）、气管插管（OR＝2．69，95％CI 1．80～4．20）、ISS≥16分（OR＝2．20，95％CI 1．20～3．91）、中心静脉压监测（OR＝4．31，95％CI 2．81～6．52）；严重创伤患者感染独立危险因素有ICU治疗时间≥2周、气管插管、中心静脉压监测。结论 ICU创伤患者并发医院感染独立因素不唯一，临床防治应从规范诊疗手段、缩短治疗时间等方面着手。

Investigation of risk factors for infections in ICU trauma patients

Objective To explore the risk factors of nosocomial infection during the trauma intensive care unit stay and provide reference for clinical prevention.Methods 983 cases of trauma ICU patients were selected, whose clinical data were retrospectively analyzed.And 983 patients were divided into infection group and non-infection group according to their infection status,univariate factors such as age were analyzed aimed at all patients.Infection group was divided into mild traumapatients （ ISS〈16 ） and severe trauma patients （ ISS≥16 ） , multivariate factors analysis were carried out aimed at infection group patients and severe trauma patients respectively.Results Independent risk factors of nosocomial infection in infection group patients were age≥60 years （ OR =1.70,95% CI 1.05 ~2.69）,time length of ICU stay≥2 weeks （OR=1.59,95% CI 1.06~2.49）,tracheacannula（OR=2.69,95% CI 1.80~4.20）,ISS score≥16（OR=2.20,95% CI 1.20-3.91）,central venousmonitoring（OR=4.31,95% CI 2.81-6.52）;independent risk factors of nosocomial infection in severe trauma patients were time length of ICU stay≥2 weeks,trachea cannula,central venous monitoring.Conclusion More than one independent risk factor are related to ICU trauma patients,standardized treatment means,shortening the treatment time and other means should be carried out to control the infection status.