目的 系統(tǒng)評價多重耐藥鮑曼不動桿菌（MDRAB）血流感染及感染后死亡危險因素，為各級醫(yī)療機構(gòu)預(yù)防MDRAB血流感染及降低感染后死亡率提供依據(jù)。方法 計算機檢索中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、萬方數(shù)據(jù)庫（Wanfang Data）、維普中文期刊全文數(shù)據(jù)庫（VIP）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、PubMed、Embase等，檢索時限為建庫至2022年10月31日，收集國內(nèi)外MDRAB血流感染及感染后死亡危險因素的病例對照研究，采用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果 共納入病例對照研究13篇，涉及感染危險因素32個，死亡危險因素25個。結(jié)果顯示合并實體瘤、惡性腫瘤、呼吸衰竭、慢性心功能不全、肺炎，入住ICU，機械通氣、氣管切開、氣管插管、留置導(dǎo)尿管、連續(xù)性血液凈化、留置引流管，感染前使用喹諾酮類、碳青霉烯類、抗真菌藥物，感染前使用抗生素≥2種，激素治療和抗生素使用不當(dāng)MDRAB血流感染組和非多重耐藥鮑曼不動桿菌（N-MDRAB）組相比，差異有統(tǒng)計學(xué)意義（P＜0.05）；合并惡性腫瘤、慢性腎臟疾病、慢性肝臟疾病、免疫抑制狀態(tài)，合并基礎(chǔ)疾病≥3種，急性生理慢性健康評分（APACHE-Ⅱ）評分高，機械通氣MDRAB血流感染后死亡組和生存組相比，差異有統(tǒng)計學(xué)意義（P＜0.05）。結(jié)論 MDRAB血流感染及感染后死亡的危險因素多，臨床診療活動中應(yīng)重視患者基礎(chǔ)疾病，嚴(yán)格把握侵入性操作指征，合理使用抗菌藥物和免疫抑制類藥物，動態(tài)評估患者生命體征，根據(jù)危險因素制定感控策略，從而降低MDRAB血流感染率和感染后死亡率。

Objective To systematically evaluate the risk factors of blood flow infection and death after infection of multidrugresistant Acinetobacter baumannii (MDRAB), so as to provide basis for medical institutions at all levels to prevent blood flow infection of MDRAB and reduce mortality after infection. Methods Data were electronically searched from CNKI, Wanfang, VIP, CBM, PubMed, Embase from the date of establishment to October 31, 2022 for the case control studies on blood flow infection of multiple drug resistant Acinetobacter baumannii and risk factors of death after infection were collected at home and abroad. RevMan 5.3 software was used for Meta-analysis. The risk factors of MDRAB bloodstream infection and death after infection were obtained. Results A total of 13 case-control studies, involved 32 risk factors of infection and 25 risk factors of death. The results showed that patients with solid tumors, malignant tumors, respiratory failure, chronic cardiac insufficiency, pneumonia, admitted to ICU, mechanical ventilation, tracheotomy, tracheal intubation, indwelling catheter, continuous blood purification, indwelling drainage tube, used quinolones, carbapenems, and antifungal drugs before infection, used ≥ two kinds of antibiotics before infection, improper hormone treatment and antibiotic use MDRAB blood flow infection group compared with non-multidrug-resistant Acinetobacter baumannii (N-MDRAB) group. The difference was statistically significant (P< 0.05). The patients with malignant tumor, chronic kidney disease, chronic liver disease, immunosuppressive state, and more than 3 basic diseases were combined. The acute physiology and chronic health evaluation Ⅱ (APACHE-II) score was high. The difference between the death group and the survival group after mechanical ventilation MDRAB blood flow infection was statistically significant (P< 0.05). Conclusion There are many risk factors for blood flow infection and death after infection of MDRAB. In clinical diagnosis and treatment, we should pay attention to the basic diseases of patients, strictly grasp the invasive operation indications, reasonably use antibacterial drugs and immunosuppressive drugs, dynamically evaluate the vital signs of patients, and formulate corresponding sensing strategies according to the risk factors, so as to reduce the blood flow infection rate and death rate after infection of MDRAB.

R965.3

四川省醫(yī)院協(xié)會2022年青年藥師科研專項資金項目（22045）；四川省醫(yī)學(xué)會（恒瑞）科研基金專項科研課題（2021HR26）；南充市科技計劃項目（22YFZJZC0047）；雅安市重點科技計劃-應(yīng)用技術(shù)研究與開發(fā)項目（22KJJH0039）