急性心肌梗死患者医院感染危险因素的Meta分析

Meta analysis on risk factors for healthcareassociated infection in patients with acute myocardial infarction

摘要:

目的系统评价急性心肌梗死（AMI）患者发生医院感染的危险因素。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data、CNKI和VIP数据库中建库至2017年12月发表的关于AMI患者医院感染危险因素的研究文献，2名研究员独立按照纳入与排除标准筛选文献、提取资料及质量评价后，应用RevMan 5.3软件进行Meta分析。结果12篇文献符合纳入标准，共13 812例AMI患者，Meta分析结果显示,12个危险因素具有统计学意义（均P＜0.05）,分别为年龄（OR=3.45，95%CI：1.02～7.95）、住院天数（OR=4.84，95%CI：2.47～7.14）、气管插管（OR=7.74，95%CI：3.73～9.02）、预防性使用抗菌药物（OR=6.79，95%CI：2.38～9.45）、机械通气（OR=2.98，95%CI：1.05～4.78）、留置导尿管（OR=3.56，95%CI：1.24～4.49）、心力衰竭（OR=3.82，95%CI：2.53～5.74）、心律失常（OR=2.47，95%CI：1.28～4.63）、糖尿病（OR=2.23，95%CI：1.62～3.27）、慢性阻塞性肺疾病（OR=2.14，95%CI：1.83～3.91）、使用H2阻滞剂（OR=2.61，95%CI：1.87～4.36）、左心室射血分数<30%（OR=2.98，95%CI：1.35～4.26）。对各危险因素发表偏倚进行分析，结果显示发表偏倚不明显。结论医护人员应及时识别医院感染的高危人群，严格把握气管插管等侵入性操作的应用指征，规范消毒隔离制度，加强无菌操作技术的过程管理，积极采取预防措施，降低AMI患者医院感染风险。

Abstract:

ObjectiveTo systematically evaluate risk factors for healthcareassociated infection(HAI) in patients with acute myocardial infarction（AMI）. MethodsLiteratures about risk factors for HAI in AMI patients were retrieved from PubMed, EMbase, the Cochrane Library, China Biological Medicine Disk (CBM), WanFang Data, China National Knowledge Infrastructure (CNKI), and VIP Database from the establishment of database to December 2017, two independent researchers screened literatures, extracted data, and evaluated quality according to inclusion and exclusion criteria, then performed Meta analysis using RevMan 5.3 software.ResultsThere are 12 literatures in accordance with the inclusion criteria, with a total sample size of 13 812 cases. According to Meta analysis, 12 risk factors were statistically significant (all P<0.05): age (OR, 3.45 ［95%CI, 1.02-7.95］), length of hospital stay(OR, 4.84 ［95% CI， 2.47-7.14］), tracheal intubation (OR, 7.74 ［95% CI, 3.73-9.02］), preventive use of antimicrobial agents (OR, 6.79 ［95% CI, 2.38-9.45］), mechanical ventilation (OR, 2.98 ［95% CI，1.05-4.78］), urinary catheterization (OR, 3.56 ［95% CI, 1.24-4.49］), heart failure(OR，3.82 ［95% CI, 2.53-5.74］), arrhythmia (OR, 2.47 ［95%CI,  1.28-4.63］), diabetes (OR， 2.23 ［95% CI, 1.62-3.27］), chronic obstructive pulmonary disease (OR， 2.14 ［95% CI, 1.83-3.91］), use of H2 blockers (OR, 2.61 ［95% CI, 1.87-4.36］), and left ventricular ejection fraction<30% (OR, 2.98 ［95% CI, 1.35-4.26］). The publication bias of each risk factor was analyzed, and the results showed that publication bias was not obvious.ConclusionHealth care workers should timely identify the highrisk population for HAI, strictly adhere to indications of invasive procedure, standardize the disinfection and isolation system, strengthen the process management of aseptic technique, and actively take preventive measures to reduce risk for HAI in AMI patients.