浙江中西医结合杂志

赵东,周诗涵,曾龙欢,徐汉乔,廖实博,郑永科.长期机械通气合并Ⅲ～Ⅳ期压疮患者的创面病原菌特点及预后研究[J].浙江中西医结合杂志,2025,35(5):

长期机械通气合并Ⅲ～Ⅳ期压疮患者的创面病原菌特点及预后研究

Study on the characteristics and prognosis of wound pathogens in patients with long-term mechanical ventilation combined with stage III-IV pressure ulcers

投稿时间：2024-11-03 修订日期：2025-03-10

DOI：

中文关键词: 长期机械通气压疮创面培养死亡风险因素

英文关键词:Long-term mechanical ventilation, pressure ulcers, wound culture, mortality risk factors.

基金项目:杭州市卫生科技计划重大项目(Z20230132)

作者	单位	E-mail
赵东	浙江中医药大学	medzhaod@163.com
周诗涵	杭州市老年病医院重症医学科
曾龙欢	杭州市老年病医院重症医学科
徐汉乔	杭州市萧山第一人民医院重症医学科
廖实博	浙江大学医学院
郑永科^*	西湖大学医学院附属杭州市第一人民医院康复科	zhengyongke@hospital.westlake.edu.cn

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中文摘要:

目的对长期机械通气合并Ⅲ～Ⅳ期压疮患者创面病原菌特点及死亡的危险因素进行分析，为临床预防和合理诊疗提供理论依据。方法：选取2020年9月-2024年6月杭州市第一人民医院城北院区重症医学科接受长期机械通气合并Ⅲ～Ⅳ期压疮的96例患者的临床信息、实验室检查结果、创面培养病原菌结果及死亡情况，分析死亡风险因素，通过受试者工作特征( receiver operating characteristic，ROC) 曲线、校准曲线、决策曲线分析(decision curve analysis，DCA)对列线图进行评估，为有效治疗相关患者、降低死亡率、改善患者的预后提供有效依据。结果：长期机械通气合并Ⅲ～Ⅳ期压疮患者共96例，创面培养总计分离出病原菌48株，其中革兰阳性菌11株(22.91%)，革兰阴性菌37株(77.09%)，前三位病原菌为大肠埃希菌（22.91%）、肺炎克雷伯杆菌（18.75%）及奇异变形杆菌（16.67%）。通过单因素分析发现：患者年龄、发生血流感染、合并高血压、肾功能不全、慢性阻塞性肺疾病、行中心静脉置管操作、血白蛋白计数、血尿素氮对死亡结果具有统计学意义(P＜0.05)。将上述因素纳入多因素logistic回归分析，结果显示血流感染(3.44 (1.02 ~ 11.55) OR (95%CI)；P=0.046)、高血压(5.28 (1.36 ~ 20.54) OR (95%CI)；P=0.016)、中心静脉置管(0.28 (0.08 ~ 0.97) OR (95%CI)，P=0.044)、血尿素氮（1.13 (1.02 ~ 1.27) OR (95%CI)，P=0.024）是导致此类患者死亡的独立危险因素，并以此构建死亡预测列线图。列线图模型预测死亡的曲线下面积( area under curve，AUC)为0.84，提示有良好的预测价值。校准曲线、DCA也表现出足够的拟合和理想的净效益，提示有较好的临床价值。结论：血流感染、中心静脉置管、高血压、血尿素氮均为长期机械通气合并Ⅲ～Ⅳ期压疮患者死亡危险因素，此类患者创面培养的主要病原菌为革兰氏阴性杆菌，临床上应关注并且做好预防。

英文摘要:

Objective: To conduct pathogen detection through wound culture and analyze risk factors for death in patients with long-term mechanical ventilation combined with stage III-IV pressure ulcers, providing a theoretical basis for clinical prevention and rational treatment. Methods: Clinical information, laboratory test results, wound culture pathogen results, and mortality data from 96 patients receiving long-term mechanical ventilation with stage III-IV pressure ulcers in the ICU of Hangzhou First People's Hospital, North City District, from September 2020 to June 2024 were collected. Risk factors for death were analyzed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) to evaluate a nomogram, providing effective evidence for treating related patients, reducing mortality, and improving patient prognosis. Results: Among the 96 patients with long-term mechanical ventilation and stage III-IV pressure ulcers, a total of 48 strains of pathogens were isolated from wound cultures, including 11 Gram-positive bacteria (22.91%) and 37 Gram-negative bacteria (77.09%). The top three pathogens identified were Escherichia coli (22.91%), Klebsiella pneumoniae (18.75%), and Proteus mirabilis (16.67%). Univariate analysis revealed that factors such as patient age, occurrence of bloodstream infection, hypertension, renal insufficiency, chronic obstructive pulmonary disease, central venous catheter placement, serum albumin levels, and blood urea nitrogen had statistical significance regarding mortality (P < 0.05). These factors were included in a multivariate logistic regression analysis, which indicated that bloodstream infection (3.44 (1.02 ~ 11.55) OR (95% CI); P = 0.046), hypertension (5.28 (1.36 ~ 20.54) OR (95% CI); P = 0.016), central venous catheterization (0.28 (0.08 ~ 0.97) OR (95% CI); P = 0.044), and blood urea nitrogen (1.13 (1.02 ~ 1.27) OR (95% CI); P = 0.024) were independent risk factors for mortality in these patients, leading to the construction of a mortality prediction nomogram. The area under the curve (AUC) for the nomogram model predicting mortality was 0.84, indicating good predictive value. Calibration curves and DCA also showed adequate fit and ideal net benefits, suggesting good clinical value. Conclusion: Bloodstream infection, central venous catheterization, hypertension, and blood urea nitrogen are risk factors for mortality in patients with long-term mechanical ventilation and pressure ulcers. The main pathogens identified in wound cultures for these patients are Gram-negative bacilli, highlighting the need for clinical attention and preventive measures.

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