ICU气管切开患者肺部感染病原菌对血清细胞因子影响的研究  

Effects of pulmonary infection pathogens on serum cytokines in tracheotomic patients in ICU

作　　者：贵艳玲[1] 蔡萍[2] 程明琨[3] 冉现蕊 冯文静[4] 

机构地区：[1]河南省肿瘤医院护理部,河南郑州450008 [2]郑州大学第一附属医院重症医学科,河南郑州450000 [3]新乡医学院第一附属医院重症医学科,河南新乡453100 [4]河南省肿瘤医院重症医学科,河南郑州450008

出　　处：《中华医院感染学杂志》2016年第11期2494-2496,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技厅基金资助项目(20149890324L)

摘　　要：目的探讨重症监护病房(ICU)气管切开患者肺部感染病原菌对血清细胞因子影响,为临床诊治提供参考。方法选取2013年8月-2015年8月于医院ICU气管切开行机械通气并发肺部感染患者为感染组,未发生肺部感染患者为未感染组,各80例;采集感染组患者痰液进行细菌培养,检测两组患者血清白细胞介素-6(IL-6)、IL-8、IL-10、IL-2R受体(IL-2R)、肿瘤坏死因子α(TNF-α)及C-反应蛋白(CRP)水平。结果感染组80例患者中61例痰液标本培养阳性,阳性率为76.25%,检出病原菌71株,其中革兰阴性菌51株、革兰阳性菌20株,分别占71.83%、28.17%;病原菌培养阳性患者中革兰阴性菌感染43例、革兰阳性菌感染18例,分别占70.49%、29.51%;感染组患者IL-6、IL-8、IL-10、IL-2R、TNF-α、CRP水平均高于未感染组,感染组中革兰阴性菌感染患者IL-6、IL-8、IL-10、IL-2R、TNF-α、CRP水平均高于革兰阳性菌感染患者,比较差异有统计学意义(P<0.05)。结论 ICU气管切开肺部患者感染病原菌以革兰阴性菌为主,血清细胞因子IL-6、IL-8、IL-10、IL-2R、TNF-α、CRP在并发肺部感染时会明显升高,革兰阴性菌感染相对于革兰阳性菌感染患者血清细胞因子升高更为明显。OBJECTIVE To discuss the effects of pulmonary infection pathogens on serum cytokines in tracheotomic patients in ICU,so as to provide references for clinical diagnosis and treatment.METHODS Patients underwent tracheostomy for mechanical ventilation in ICU of our hospital from Aug.2014 to Aug.2015 were selected and divided into infection group with pulmonary infection and non infection group without pulmonary infection,with 80 cases in each group.The sputums of infection group were gathered and cultured.The interleukin-6（I-6）,interleukin-8（IL-8）,interleukin-10（IL-10）,interleukin-2receptor（IL-2R）,tumor necrosis factor alpha（TNF-α）,and Creactive protein（CRP）of the two groups were detected.RESULTS Pathogenic bacteria were detected in 61 cases of sputum specimens in 80 patients in the infection group,with the positive rate of 76.25%.There were 71 strains of pathogenic bacteria,including 51 strains of gram-negative bacteria and 20 strains of gram-positive bacteria,accounting for 71.83%and 28.17%.There were 43 strains of gram-negative bacteria and 18 strains of gram-positive bacteria in pathogenic bacteria positive patients,accounting for 70.49% and 29.51%.The levels of IL-6,IL-8,IL-10,IL-2R,TNF-αand CRP of infection group were higher than those of non infection group.The levels of IL-6,IL-8,IL-10,IL-2R,TNF-αand CRP of gram-negative bacteria infection patients were significently higher than those of gram-positive bacteria infection patients（P〈0.05）.CONCLUSIONThe pathogenic bacteria in tracheotomic patients in ICU were mainly gram-negative bacteria,serum cytokines levels of IL-6,IL-8,IL-10,IL-2R,TNF-αand CRP were increased in the event of pulmonary infections.The serum cytokines levels in patients with gramnegative bacteria infection were increased higher than those in patients with gram-positive bacteria infection.

关 键 词：肺部感染 重症监护病房 气管切开 病原菌 细胞因子 

分 类 号：R563.1[医药卫生—呼吸系统]