急性胃肠穿孔患者病原菌特点及休克相关因素分析  

Analysis of the characteristics of pathogenic bacteria and factors associated with shock following acute gas-trointestinal perforation

作　　者：马兴龙 谢菲 唐奇 付磊 谢鹏 MA Xinglong;XIE Fei;TANG Qi;FU Lei;XIE Peng(The First People′s Hospital of Zunyi(The Third Affiliated Hospital of Zunyi Medical University),Zunyi 563002,China)

机构地区：[1]遵义市第一人民医院(遵义医科大学第三附属医院)重症医学科,贵州遵义563002

出　　处：《实用医学杂志》2020年第18期2536-2540,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:31360256,31660290);遵义市联合基金(编号:遵市科合社字(2015)05号)。

摘　　要：目的探讨急性胃肠穿孔患者病原菌特点及发生脓毒症休克的相关因素。方法选择2016年6月至2019年6月遵义医科大学第三附属医院重症医学科收治的急性胃肠穿孔患者159例为研究对象,分析患者病原菌感染的病原学特点,根据病情分为脓毒症休克组和非脓毒症休克组。比较两组患者的一般资料(性别、年龄、穿孔部位、基础疾病)、白细胞计数(WBC)、降钙素原(PCT)水平、急性生理学及慢性健康状况评分(APACHEⅡ)的差异,并使用多因素Logistic回归进行脓毒症休克的相关因素分析。结果共126株病原菌被分离,其中革兰阴性菌83株占65.81%,以大肠埃希菌为主;革兰阳性菌32株占25.40%,以屎肠球菌为主;真菌11株占8.73%,以白念珠菌为主。主要革兰阴性菌均对氨苄西林具有较高的耐药性,对头孢哌酮/舒巴坦、美罗培南耐药性较低;主要革兰阳性菌对氨苄西林、头孢曲松耐药性较高,对万古霉素、利奈唑胺无耐药性。159例急性胃肠穿孔患者43例发生脓毒症休克,占27.04%。年龄、APACHEⅡ、合并基础疾病是脓毒症休克发生的影响因素(P<0.05)。结论革兰阴性菌为急性胃肠穿孔主要致病菌。患者发生脓毒症休克与年龄、APACHEⅡ、合并基础疾病具有显著相关性。Objective To investigate the characteristics of pathogenic bacteria after acute gastrointestinal perforation(GIP)and analyze the factors associated with septic shock.Methods A total of 159 patients with acute GIP treated in the Department of Critical Medicine,the Third Affiliated Hospital of Zunyi Medical University,between June 2016 and June 2019 were enrolled as the research subjects.The etiological characteristics of the pathogenic infections were analyzed,and patients were divided into a septic shock group and a non-septic shock group based on their condition.The general characteristics(sex,age,site of perforation,underlying diseases),white blood cell(WBC)count,procalcitonin(PCT)level,and Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore of the two groups were compared,and multivariate logistic regression was used to analyze factors associated with septic shock.Results A total of 126 strains of pathogenic bacteria were isolated.83 strains of gram-negative bacteria accounted for 65.81%,of which Escherichia coli was the major species;32 strains of gram-positive bacteria accounted for 25.40%,of which Enterococcus faecium was the major species;and 11 strains of fungi accounted for 8.73%,of which Candida albicans was the major species.The major gram-negative bacteria were more resistant to ampicillin and less resistant to cefoperazone/sulbactam and meropenem.The major gram-positive bacteria were more resistant to ampicillin and ceftriaxone and had no resistance to vancomycin or linezolid.Among the 159 patients with acute GIP,septic shock occurred in 43 patients,accounting for 27.04%.Age,APACHEⅡscore,and underlying disease were the influencing factors of septic shock(P<0.05).Conclusion Gram-negative bacteria are the main pathogens involved in acute GIP.The development of septic shock in patients was significantly associated with age,APACHEⅡscore,and underlying disease.

关 键 词：胃肠穿孔 术后 病原菌 脓毒症 休克 相关因素 

分 类 号：R631.4[医药卫生—外科学]