慢性心力衰竭合并重症院内感染性肺炎患者应激状况及炎症指标水平检测分析  

Detection and analysis of stress status and inflammatory markers in patients with chronic heart failure complicated with severe nosocomial infectious pneumonia

作　　者：王晨 水颖 陈学清 吴建荣 鲍千红 WANG Chcn;SHUI Ying;CHEN Xue-qing;WU Jian-rong;BAO Qian-hong(Ling'an District People's Hospital of Hangzhou,Hangzhou,Zhejiang 311300,China)

机构地区：[1]杭州市临安区人民医院重症监护室,浙江杭州311300 [2]杭州市临安区人民医院检验科细菌室,浙江杭州311300

出　　处：《中华医院感染学杂志》2019年第23期3581-3585,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(2015KYA182)

摘　　要：目的研究慢性心力衰竭合并重症院内感染性肺炎患者应激状况及炎症指标水平,并对患者的病原菌及耐药状况进行分析。方法选择2017年6月-2018年6月杭州市临安区人民医院接诊的105例慢性心力衰竭患者进行研究。按照是否合并重症院内感染性肺炎,将患者分为研究组(感染组)和对照组(未感染组)。对患者的应激状况[超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)及氧化低密度脂蛋白(Oxidized low density lipoprotein,Ox-LDL)]及炎症指标[肿瘤坏死因子-α(Tumor necrosis factor alpha,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、脑钠肽(brain natriuretic peptide,BNP)、C-反应蛋白(C-reactive protein,CRP)及降钙素原(Procalcitonin,PCT)]进行检测,并对感染患者病原菌及耐药状况进行分析。结果研究组患者的SOD水平为(70.62±9.83)ρ/U·ml-1,高于对照组的(46.82±10.03)ρ/U·ml-1(P<0.05),MDA及Ox-LDL水平分别为(2.87±0.83)c/nmol·ml-1、(0.28±0.11)ρ/kU·L-1,低于对照组的(4.76±0.32)c/nmol·ml-1、(0.52±0.13)ρ/kU·L-1,差异均有统计学意义(P<0.05)。研究组患者的TNF-α、IL-6、BNP、CRP及PCT水平均高于对照组患者,差异均有统计学意义(P<0.05)。45例医院感染患者,共分离出56株病原菌,革兰阳性菌23株,占41.07%,其中以肠球菌为主;革兰阴性菌32株,占57.14%。结论慢性心力衰竭合并重症院内感染性肺炎患者应激状况及炎症指标水平出现明显变化。分离的菌株以革兰阴性菌为主,对亚胺培南、美罗培南、头孢哌酮舒巴坦及阿米卡星等抗菌药物较为敏感,可指导临床用药。OBJECTIVE To study the stress status and inflammation index level of patients with chronic heart failure complicated with severe nosocomial infectious pneumonia,and to analyze the pathogens and drug resistance of patients.METHODS Totally 105 patients with chronic heart failure admitted to Linan District People’s Hospital of Hangzhou from Jun.2017 to Jun.2018 were studied.Patients were divided into the study group(infected group)and the control group(uninfected group)according to whether they were complicated with severe nosocomial pneumonia.Stress status[superoxide dismutase(SOD),malondialdehyde(MDA),oxidized low density lipoprotein(Ox-LDL)]and inflammation indicators[Tumor necrosis factor alpha(TNF-alpha),interleukin-6(IL-6),brain natriuretic peptide(BNP),C-reactive protein(CRP)and procalcitonin(PCT)]were detected,and the pathogens and drug resistance were analyzed.RESULTS The SOD level of the study group was(70.62+9.83)P/U·ml-1,significantly higher than that of the control group(46.82±10.03)P/U·ml-1(P<0.05),MDA and Ox-LDL levels were(2.87±0.83)c/nmol·ml-1,(0.28±0.11)P/kU·L-1,significantly lower than those of the control group(4.76±0.32)c/nmol·ml-1,(0.52±0.13)P/kL-1(P<0.05).The levels of TNF-α,IL-6,BNP,CRP and PCT in the study group were significantly higher than those in the control group(P<0.05).In 45 cases of nosocomial infection,56 strains ofpathogens were isolated,of which 23 were Gram-positive bacteria(41.07%),32 were Gram-negative bacteria(57.14%)and 1 was fungus(1.79%).The dominant Gram-positive bacteria were Enterococci.CONCLUSION The stress status and inflammation index of patients with chronic heart failure complicated with severe nosocomial infectious pneumonia have obvious changes.Gram-negative bacteria were the main isolates,which were sensitive to imipenem,meropenem,cefoperazone sulbactam and amikacin,and could guide the clinical use of antibiotics.

关 键 词：慢性心力衰竭 感染性肺炎 重症 脑钠肽 应激 炎症 

分 类 号：R563.1[医药卫生—呼吸系统]