有机磷中毒合并呼吸衰竭患者继发肺部感染的相关因素分析

摘要

Objective To study the related factors of secondary pulmonary infection in patients with organophosphorus poisoning complicated by respiratory failure, and provide scientific basis for early preventing and controlling of infection. Methods The clinical data of 112 cases with acute organophosphorus poisoning complicated by respiratory failure were analyzed retrospectively, and correlation of pulmonary infection and patients' age, complicated aspiration, using ventilator and blood glucose etc were analyzed by Logistic stepwise regression analysis. Results Univariate analysis showed that pulmonary infection was associated with age, combined aspiration, ventilator, blood glucose, acute physiology and chronic health evaluation M ( APACHE M ), cholinesterase activity, hand hygiene, sensitivity C - reactive protein, disturbance of consciousness and the use of sedatives after ventilator support,ICU days and so on. Multivariate Logistic regression analysis showed that combined aspiration, use of breathing machines, hand hygiene, the degree of cholinesterase activity reduction had significant effects on secondary pulmonary infection. Conclusion The combined aspiration, the use of breathing machines, hand hygiene, the level of cholinesterase activity reduction are risk factors of secondary pulmonary infection in patients with organophorus poisoning complicated by respiratory failure.%目的 探讨有机磷中毒合并呼吸衰竭患者继发肺部感染的相关因素,为及早有效预防并控制感染提供科学依据.方法 回顾分析重症有机磷中毒合并呼吸衰竭患者112例的临床资料,用Logistic逐步回归法分析患者年龄、合并误吸、使用呼吸机、血糖等因素与肺部感染的相关性.结果 单因素分析提示,年龄、合并误吸、使用呼吸机、血糖、急性生理学和慢性健康状况评分Ⅲ时间、胆碱酯酶活性、手卫生、超敏C反应蛋白、意识障碍或呼吸机支持后镇静剂的使用、住ICU时间等因素与继发肺部感染有关.多因素Logistic回归分析提示,合并误吸、使用呼吸机、手卫生,胆碱酯酶活性的降低程度对继发肺部感染有显著影响.结论 合并误吸、使用呼吸机、手卫生,胆碱酯酶活性的降低程度是导致重症有机磷中毒合并呼吸衰竭患者继发肺部感染的危险因素.