陈慧兰 游秋萍 孙萍

【摘要】目的：探討ICU多重耐药菌感染的护理防控要点与传播的预警模式构建。方法：选择2018年9月至2020年8月期间ICU病房住院病人82例作为对象，调查ICU多重耐药感染情况，分为病例组和对照组。查阅两组病历资料，记录患者性别、年龄、基础疾病、ICU住院天数、使用呼吸机天数、发热、低蛋白血症、抗菌药物的联用、BMI、手术等，完成单因素和多因素Logistic分析；并进行参数估计和优势比OR评估，绘制ROC曲线面积，计算预警模型的效能。结果：单因素及多因素Logistic分析结果表明：ICU多重耐药菌感染率与ICU住院时间、基础疾病、使用呼吸机天数、低蛋白血症、抗菌药物联用及发热具有统计意义（P<0.05）；ROC曲线结果表明：预警模型对ICU MDRO感染的护理防控要点与传播的的C-index为0.816，具有良好的区分度；曲线下面积为0.832，95%CI为0.757～0.899，具有良好的预测效能。结论：ICU多重耐药菌感染率较高，建立护理防控要点与传播的预警模式具有良好的区分度，能获得较高的预测效能，值得推广应用。

【关键词】ICU多重耐药菌；护理防控要点；传播；预警模式；ROC曲线面积

[中图分类号]R473 [文献标识码]A [文章编号]2096-5249（2021）11-0096-02

Essentials of Nursing Prevention and Control of Multi-drug-resistant Bacteria Infection in ICU and Construction of Early Warning Model of Transmission

CHEN Hui-lan1， YOU Qiu-ping2， SUN Ping1 （Department of Critical Care Medicine， Third Bureau Hospital， Dongguan Guangdong 523710， China； 2. Hospital Inpatient Office of Dongguan Third Bureau Hospital， Dongguan Guangdong 523710， China）

[Abstract] Objective： To explore the key points of nursing prevention and control of multi-drug-resistant bacterial infection in ICU and the construction of early warning mode of transmission. Methods： A total of 82 inpatients in the ICU ward from September 2018 to August 2020 were selected as subjects to investigate the multi-drug-resistant infection in the ICU， and they were divided into a case group and a control group. Check the medical records of the two groups， record the patient’s gender， age， underlying diseases， ICU hospitalization days， ventilator days， fever， hypoproteinemia， combination of antibacterial drugs， BMI， surgery， etc. ， complete single-factor and multi-factor Logistic analysis ； And perform parameter estimation and odds ratio OR evaluation， draw the ROC curve area， and calculate the effectiveness of the early warning model. Results： Univariate and multivariate logistic analysis results showed that： ICU infection rate of multi-drug resistant bacteria was statistically significant with ICU hospitalization time， underlying diseases， ventilator days， hypoproteinemia， combination of antibacterial drugs， and fever （P<0.05）； ROC curve results show that the C-index of the early warning model for the prevention and control of ICU MDRO infection is 0.816， which has a good degree of discrimination； the area under the curve is 0.832， and the 95% CI is 0.757-0.899， which is good Predictive performance. Conclusion： The infection rate of multi-drug-resistant bacteria in ICU is relatively high. The establishment of nursing prevention and control points and the early warning mode of transmission have a good degree of distinction， can obtain high prediction efficiency， and is worthy of popularization and application.

[Key words] ICU multi-drug resistant bacteria； Key points of nursing prevention and control； Transmission； Early warning mode； ROC curve area

多重耐药菌（Multidrug resistant organism，MDRO）是住院患者发生医院感染的主要病原菌，而综合ICU是医院MDRO感染高发科室[1]。近年来，随着以来市场的不断发展，再加上广谱抗菌药物的不合理使用，导致MDRO感染率呈上升趋势。因此，临床上如何有效的控制MDRO感染的发生于传播成为当前研究的热点。既往研究表明：加强ICU多重耐药菌护理要点分析，加强教育培训、完善卫生设施及加强消毒管理等，能进一步完善管理机制，更加重视患者用药护理[2]。……