Antonelli M, Moro M L, D'Errico R R, Conti G, Bufi M, Gasparetto A
Istituto di Anestesiologia e Rianimazione, Università La Sapienza, Policlinico Umberto, Rome, Italy.
Intensive Care Med. 1996 Aug;22(8):735-41. doi: 10.1007/BF01709514.
The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma.
A prospective study conducted on 141 consecutive trauma patients.
A general intensive care unit (ICU) of a university hospital.
All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severity of coma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma.
Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (chi 2 = 4.1, P = 0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1).
Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
本研究旨在确定创伤后早期菌血症（EOB）和迟发性菌血症（LOB）的危险因素，并描述其流行病学特征。
对141例连续的创伤患者进行前瞻性研究。
一所大学医院的综合重症监护病房（ICU）。
1990年12月至1992年5月入住我院综合重症监护病房的所有多发伤患者均被前瞻性纳入研究。收集每位患者的以下信息并记录在计算机数据库中：人口统计学资料、根据简明损伤定级标准（AIS）评估的创伤严重程度、根据格拉斯哥昏迷量表（GCS）评估的昏迷严重程度、气胸、肺挫伤、肋骨骨折、血胸和腹部创伤的情况、机械通气的使用情况以及中心静脉导管的放置情况。菌血症若在创伤后96小时内发病则定义为EOB，若在创伤后96小时后出现则定义为LOB。
37例患者在ICU住院期间发生菌血症（26%）：11例（29.7%）为EOB，26例（70.3%）为LOB。革兰氏阳性球菌在EOB中比在LOB中更频繁地分离出来（χ2 = 4.1，P = 0.0
4）。肺挫伤的存在（相对危险度[RR] 15.0；可信区间[CI] 1.99 - 113.25）、菌血症发作前的肺炎（RR 3.56；CI 1.17 - 10.69）、AIS评分大于32以及腹部损伤评分大于9（RR 3.11；CI 1.02 - 9.49）显著增加了EOB的风险，而血管内导管和机械通气并非EOB的危险因素。LOB有非常不同的模式，接触血管内导管（RR 4.96；CI 1.23 - 19.94）和持续超过7天的机械通气（RR 3.6；CI 1.6 - 8.1）显著增加了其风险。
在ICU入院时用AIS对腹部和胸部创伤进行评分似乎是识别有增加EOB风险的创伤患者的有用工具。作为减少创伤患者迟发性菌血症的一种手段，严格的导管放置和维护政策至关重要。
