ICU肺炎克雷伯菌血流感染中西医临床特点及预后危险因素分析OA
Analysis of Clinical Characteristics and Prognostic Risk Factors of Integrated Traditional Chinese and Western Medicine for Klebsiella Pneumoniae Bloodstream Infection in ICU
目的 探寻ICU肺炎克雷伯菌血流感染患者中西医临床特点及短期死亡的危险因素.方法 回顾性选取2017年5月至2025年1月首都医科大学附属北京中医医院重症医学科收治的37例肺炎克雷伯菌血流感染患者的临床资料,根据治疗28 d后死亡与否,将患者分为死亡组(19例)和存活组(18例).分析患者中西医临床特点,采用Cox回归分析患者死亡的独立危险因素.结果 患者年龄53～94岁之间,均具有基础病,血流感染来源多为下呼吸道感染、泌尿系感染.死亡组与存活组相比,APACHE Ⅱ评分、SOFA评分更高,有创机械通气患者、感染性休克患者更多,入住ICU后发病时间更长(P＜0.05).中医方面,气营两燔证患者占比83.8％,死亡组患者出现神志改变、四肢厥冷多于存活组(P＜0.05).多因素分析发现,急性生理与慢性健康状况Ⅱ(APACHE Ⅱ)评分升高、神志改变是ICU肺炎克雷伯菌血流感染患者28 d死亡的独立危险因素.结论 ICU肺炎克雷伯菌血流感染患者中医辨证多为气营两燔证,脓毒性休克、SOFA评分升高、有创机械通气治疗、神志改变、四肢厥冷均与疾病预后相关;ICU肺炎克雷伯菌血流感染发生时APACHE Ⅱ评分、神志改变是预后的独立危险因素.
Objective:To explore the clinical characteristics and risk factors of integrated traditional Chinese and western medicine for short-term death in ICU patients with Klebsiella pneumoniae bloodstream infection.Methods:A retrospective analysis was conducted on the clinical data of 37 patients with Klebsiella pneumoniae bloodstream infection admitted to the Department of Critical Care Medicine,Beijing Hospital of Traditional Chi-nese Medicine Affiliated to Capital Medical University from May 2017 to January 2025.According to the survival status 28 days after the initiation of treatment,the patients were divided into a death group(19 cases)and a surviv-al group(18 cases).The integrated traditional Chinese and western medicine clinical characteristics of the patients were analyzed,and Cox regression analysis was used to identify the independent risk factors for death.Results:The age of the patients ranged from 53 to 94 years old,all of whom had underlying diseases.The main sources of bloodstream infection were lower respiratory tract infection and urinary tract infection.Compared with the survival group,the death group had higher APACHE Ⅱ scores and SOFA scores,a higher proportion of patients receiving invasive mechanical ventilation and suffering from septic shock,and a longer time from ICU admission to onset(P＜0.05).In terms of traditional Chinese medicine(TCM)syndrome differentiation,83.8％of the patients were di-agnosed with syndrome of flaring heat in qifen and yingfen.The death group had a higher incidence of altered mental status and cold extremities than the survival group(P＜0.05).Multivariate analysis showed that elevated APACHE Ⅱ score and altered mental status were independent risk factors for 28 days death in ICU patients with Klebsiella pneumoniae bloodstream infection.Conclusion:Most ICU patients with Klebsiella pneumoniae blood-stream infection are diagnosed with syndrome of flaring heat in qifen and yingfen in TCM.Septic shock,elevated SOFA score,invasive mechanical ventilation,altered mental status and cold extremities are all associated with the prognosis of the disease.Elevated APACHE Ⅱ score and altered mental status at the onset of Klebsiella pneumoni-ae bloodstream infection in ICU are independent risk factors for prognosis.
张鑫;杨思雯;张羽;陈腾飞
首都医科大学附属北京中医医院,北京 100010首都医科大学附属北京中医医院,北京 100010首都医科大学附属北京中医医院,北京 100010首都医科大学附属北京中医医院,北京 100010
医药卫生
血流感染肺炎克雷伯菌重症监护室中西医气营两燔
Bloodstream infectionKlebsiella pneumoniaeIntensive care unitIntegrated traditional Chinese and western medicineSyndrome of flaring heat in qifen and yingfen
《中国中医急症》 2026 (1)
42-46,51,6
北京市属医院科研培育计划(PZ2023011)
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