创伤后ARDS机械通气患者早期肺部感染危险因素分析

摘要

目的：研究探讨创伤后ARDS机械通气患者早期并发肺部感染的危险因素。方法选取2010年1月至2013年12月从我院ICU收治的创伤后ARDS机械通气患者67例,分为肺部感染组和非肺部感染组,30位健康志愿者作为正常对照组。结果64例严重创伤后并发ARDS患者入选,肺部感染1例。三组患者性别构成和年龄差异无统计学意义(P>0.05)；急性生理与慢性健康评分(APACHEⅡ)、创伤严重程度评分(ISS)和30天死亡率比较,肺感染组显著高于非肺感染组间(P<0.05)；氧合指数、呼吸机通气时间、人工气道留置时间和ICU治疗时间,非肺部感染组与肺部感染组之间差异有统计学意义(P<0.01)；肺感染组胸部损伤的构成比显著高于非肺部感染组,差异有统计学意义(P<0.05)；和正常对照组比较,肺部感染组和非肺部感染组的血清C反应蛋白( CRP)、降钙素原( PCT)和可溶性髓样细胞触发受体-1( sTREM-1)水平显著升高,差异有统计学意义(P<0.01),肺部感染组血清CRP、PCT和sTREM-1水平比非肺部感染组的显著升高,差异有统计学意义(P <0.05)；和正常对照组比较,非肺部感染组和肺部感染组的支气管肺泡灌洗(BAFL)sTREM-1水平显著升高,差异有统计学意义(P<0.01),肺部感染组BAFL的CRP、PCT和sTREM-1水平比非肺部感染组的显著升高,差异有统计学意义(P<0.05)。单因素logistic回归分析显示胸部损伤、ISS评分、APACHEⅡ评分、血清的CRP 、PCT和sTREM-1水平以及BAFL的sTREM-1水平影响因素；多因素logistic回归分析显示APECHE Ⅱ评分及BAFL的sTREM-1水平。结论胸部损伤、ISS评分、血清的CRP、PCT和sTREM-1水平可在一定程度上可预测早期肺部感染,但只有APACHEⅡ评分和BAFL的sTREM-1水平是创伤后ARDS患者早期并发肺部感染的独立危险因素。%Objective To investigate the risk factors for lung infection in post-traumatic ARDS patients with mechanic ventilation. Methods 67patients who were admitted by our hospital’s ICU department because of post-traumatic ARDS from Janu-ary,2010 to December,2013 were randomly divided into two groups, the infected group and the non-infected group. 30 healthy volunteers were selected as the control group. Results 64 sever post-traumatic ARDS patients were chosen among which 34 were lung infected and 30 were not. The infected rate was 53%. There were no significance of sex composition and age among three groups(P>0. 05). APACHEⅡ, ISS, 30-day mortality, the constituent ratio of thoracic injury, the serum level of CRP, PCT and s-TREM-1 of the infected group were much higher than the non infected group(P<0. 05). There was significance of Oxygenation index, the time of mechanic ventilation, Artificial airway indwelling and ICU staying between the infected and non infected group (P<0. 01). Compared with the control group, the serum level of CRP, PCT and sTREM-1 of the infected and non infected group were significantly increased(P<0. 05), and the level of sTREM-1 after BAFL were significantly increased as well(P<0. 01). The level of CRP, PCT and sTREM-1 after BAFL in the infected group were significantly higher than the non infected group( P<0. 05). Univariate logistic regression analysis showed that factors whose p-value were less than 0. 05 were the thoracic injury, ISS, APACHE Ⅱ, the level of CRP, PCT and sTREM-1 and the level of sTREM-1 after BAFL. Multi-factor logistic regression analysis showed that factors whose p-value were less than 0. 05 were the APACHEⅡand the level of sTREM-1 after BAFL. Conclusion Thoracic injury, ISS, the serum level of CRP, PCT and sTREM-1 can predict the lung infection in some degree. But only the A-PACHEⅡand the serum level of BAFL and sTREM-1 are the independent risk factors for lung infection.