老年骨科手术全身麻醉患者感染病原菌分布及对氧化应激水平的影响  

The distribution of pathogenic bacteria in elderly patients with infection after orthopedics surgery with general anaesthesia and their effects on oxidative stress levels of patients

作　　者：钟庆[1] 李娟[2] 翁艳[1] 杨岸 何发友 田鹏[3] 雷海[3] 黄光平[3] ZHONG Qing;LI Juan;WENG Yan(Department of Anesthesiology and Pain Medicine,Jianyang People’s Hospital,Sichuan,Jianyang 641400,China)

机构地区：[1]四川省简阳市人民医院麻醉疼痛科,641400 [2]四川省简阳市人民医院呼吸科,641400 [3]四川省简阳市人民医院骨科,641400

出　　处：《河北医药》2019年第20期3126-3129,共4页Hebei Medical Journal

基　　金：四川省卫生和计划生育委员会科研课题(编号:17PJ212);简阳市人民医院科研基金重点项目(编号:JY201708)

摘　　要：目的对老年骨科全身麻醉手术患者感染病原菌分布进行分析,探讨其对患者ROS水平和NADPHoxidase的影响,为相关的临床治疗提供借鉴。方法回顾分析2011年7月至2016年7月收治的84例老年骨科全身麻醉手术感染患者临床资料,分析全自动细菌鉴定系统分析感染病原菌的类别及构成比,药敏试验分析致病菌耐药性,酶联免疫吸附测定法分析患者ROS水平和NADPHoxidase的水平变化。结果老年骨科全身麻醉手术患者感染病原菌中革兰阳性菌48株,占57.1%,革兰阴性菌36株,占42.9%;感染病原菌患者ROS相关指标SOD和CAT水平明显低于术前和术后未感染病原菌组患者(P<0.05);而MDA和NADPH oxidase相关亚基P22、P47和P67蛋白水平明显高于术前和术后未感染病原菌组患者(P<0.05);分离的病原菌对多数抗生素较敏感,但革兰阳性菌对磺胺甲恶唑/甲氧苄啶和万古霉素较敏感,革兰阴性菌对头孢唑啉和亚胺培南较敏感。结论老年骨科全身麻醉手术患者感染病原菌以革兰阳性菌为主,对抗菌药物有较强的耐药性,且感染能引起患者体内ROS和NADPHoxidase水平的升高。Objective To explore the distribution of pathogenic bacteria in elderly patients with infection after orthopedics surgery with general anaesthesia and their effects on serum levels of ROS and NADPH oxidase.Methods The clinical data about 80 elderly patients who underwent orthopedic surgery under general anesthesia in our hospital from July 2011 to July 2016 were retrospectively analyzed.The category and constituent ratio of pathogens were identified by VITEK Compact 2,and the drug resistance of pathogenic bacterium was detected by means of drug sensitive test,moreover,the changes of levels of ROS and NADPH oxidase were detected by ELISA.Results The results showed that the pathogens separated from the patients included 48 strains of gram positive ones(57.1%)and 36 strains of gram negative ones(42.9%).The levels of ROS related indexes including SOD and CAT were significantly lower than those before operation and those of patients without infection after operation(P<0.05),however,the levels of MDA and NADPH oxidase related subunit-P22,P47 and P67 were significantly higher than those before operation and those of patients without infection after operation(P<0.05).In addition the separated pathogens were sensitive to most of the antibiotics,moreover,the Gram-positive bacteria were more sensitive to sulfamethylisoxazole/trimethoprim and vancomycin,however,Gram-negative bacteria were more sensitive to cephazolin and imipenem.Conclusion The elderly patients who undergo orthopedic surgery are easily affected by pathogens,mainly Gram-positive bacteria that have powerful drug resistance to antibacterials,moreover,which can result in the increase of the levels of ROS and NADPH oxidase of patients.

关 键 词：全身麻醉 反应氧自由基 NADPH氧化酶 耐药性 敏感 

分 类 号：R614.2[医药卫生—麻醉学]