摘要
目的系统评价成年患者体外膜肺氧合(ECMO)治疗期间医院感染发病率及其危险因素,为医护人员早期识别医院感染并制定预防措施提供循证依据。方法系统检索万方、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)、Cochrane Library、Web of Science、PubMed、Embase中有关成年患者ECMO治疗期间医院感染发病率及危险因素的文献,检索时限为建库至2025年2月1日,应用Stata 12.0软件进行分析。结果本研究纳入28篇文献,共监测24690例接受ECMO治疗的患者,其中有3244例发生医院感染。Meta分析结果显示,成年患者ECMO治疗期间医院感染发病率为31.0%。亚组分析结果表明,在调查时间为2020年及以后、主要感染类型为下呼吸道感染、主要感染菌群为铜绿假单胞菌的研究中,患者医院感染发病率更高(分别为36.5%、41.4%、40.6%)。成年患者ECMO治疗期间医院感染的危险因素包括气管插管或气管切开(OR=7.838)、联合连续性肾脏替代治疗(CRRT,OR=1.578)、静脉-静脉体外膜肺氧合(V-V ECMO)治疗模式(OR=2.022)、ECMO治疗时间≥72 h(OR=1.022)、机械通气时长≥9 d(OR=1.051)、身体质量指数(BMI)≥24 kg/m2(SMD=0.154)、年龄≥45岁(OR=1.043)、序贯器官衰竭评分较高(OR=1.058)、入院时感染(OR=3.035)、合并糖尿病史(OR=2.242)、合并重症监护病房(ICU)转入史(OR=2.324)。结论成年患者在ECMO治疗期间,医院感染危险因素较多,发病率较高。医护人员应高度重视医院感染问题,准确识别高风险人群及危险因素,并通过多学科协作,制定全程、细致和个性化的干预措施,以预防治疗期间的医院感染。
Objective To systematically evaluate the incidences and risk factors of healthcare-associated infection(HAI) in adult patients during extracorporeal membrane oxygenation(ECMO)treatment,and provide evidence-based reference for healthcare workers(HCWs)to early identify HAI and formulate preventive measures.Methods Literatures related to the incidences and risk factors of HAI in adult patients during ECMOtreatment period were retrieved from Wanfang,China Biomedicine(CBM),China National Knowledge Infrastructure(CNKI),VIP Data base,Cochrane Library,Web of Science,PubMed,and Embase.The search time was from the establishment of the databases to February 1,2025.Stata 12.0 software was used for analysis.Results28 literatures were included in this study,and a total of 24690 patients recciving ECMO treatment were monitored,out of which 3244 had HAL.Meta-analysis showed that the incidence of HAI in adult patients during ECMOtreatment period was 31.0%.Subgroup analysis showed that in the studies that the survey time was 2020 and later,the main type of infection was lower respiratory tract infection,and the main infection flora was Pseudomonas aeruginosa,the incidences of HAI in patients were higher(36.5%,41.4%,40.6%,respectively).The risk factors for HAI in adult patients during ECMO treatment period included tracheal intubation or tracheotomy(OR=7.838),combined continuous renal replacement therapy(CRRT,OR=1.578),veno-venous ECMO(V-V ECMO)treatment mode(OR=2.022),duration of ECMO treatment≥72 hours(OR=1.022),duration of mechanical ventilation≥9 days(OR=1.051),body mass index(BMI)≥24 kg/m(SMD=0.154),age≥45 years old(OR=1.043),high score of sequential organ failure score(OR=1.058),infection on admission(OR=3.035),combined history of diabetes mellitus(OR=2.242),and history of staying in intensive care unit(ICU)(OR=2.324).ConclusionThere are multiple risk factors for HAI in adult patients during ECMO treatment period,and the incidence is high.HCWs should pay more attention to HAI,accurately identify high-risk populations and risk factors,and formulate comprehensive,detailed,and personalized intervention measures through multidisciplinary collaboration,so as to prevent HAI during treatment period.
作者
王薏萱
程玲灵
王雾
石爱丽
WANG Yixuan;CHENG Lingling;WANG Wu;SHI Aili(School of Nursing,Hangzhou Normal University,Hangzhou 311121,China;Department of Emergency Medicine,Zhejiang Provincial People’s Hospital/People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China;Department of Nursing,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)
出处
《中国感染控制杂志》
北大核心
2025年第12期1838-1847,共10页
Chinese Journal of Infection Control
基金
浙江省医药卫生科技计划项目(2025KY609)。
关键词
体外膜肺氧合
医院感染
发病率
危险因素
META分析
extracorporeal membrane oxygenation
healthcare-associated infection
incidence
risk factor
Metaanalysis
