老年重症感染性休克患者病原菌分布特点及心功能、炎性因子指标变化的临床分析  

Clinical analysis of pathogenic bacteria distribution characteristics and changes of cardiac function and inflammatory factors in elderly patients with severe septic shock

作　　者：刘英 李群[2] 常文静[2] 郑云辉 臧学峰[2] Liu Ying;Li Qun;Chang Wenjing;Zheng Yunhui;Zang Xuefeng(Department of Infections Diseases,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Critical Care Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院感染科,100038 [2]首都医科大学附属北京世纪坛医院重症医学科,100038

出　　处：《中华损伤与修复杂志（电子版）》2021年第1期59-63,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨老年重症感染性休克患者病原菌分布特点及心功能状态、炎性因子变化趋势与病情的关系。方法选取首都医科大学附属北京世纪坛医院2017年6月至2019年6月收治的96例老年重症感染性休克患者为研究对象,根据患者预后情况分为存活组(n=66)和死亡组(n=30)。对患者进行病原菌的采集与鉴定;检测患者入院后心功能指标如左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD)并计算左心室射血分数(LVEF);分别于入院即刻,入院6、24 h采用酶联免疫吸附试验检测2组患者白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平,对患者进行急性生理学与慢性健康评分Ⅱ(APACHE-Ⅱ)评分,对炎性因子IL-6、CRP、PCT水平与APACHE-Ⅱ评分进行Pearson相关系数分析。数据比较采用t检验、卡方检验或Fisher确切概率法。结果96例患者中共分离出病原菌111株,其中革兰氏阴性菌76株,占比68.47%,以大肠杆菌为主,有27株(24.32%);革兰阳性菌32株占28.83%,以金黄色葡萄球菌为主,有17株(15.31%);真菌3株,占比2.70%。存活组患者心功能指标LVESD(40.87±2.04)mm、LVEDD(51.56±1.97)mm明显低于死亡组[(42.88±1.77)、(53.78±1.88)mm],LVEF 59.54±8.43明显高于死亡组(50.33±7.86),2组比较差异均有统计学意义(t=5.582、5.190、5.065,P<0.05);存活组患者的炎性因子IL-6、CRP、PCT水平及APACHE-Ⅱ评分在入院即刻,入院6、24 h呈逐渐降低趋势,各指标3个时间点整体比较,差异均有统计学意义(F=70.375、563.830、1461.640、236.414,P<0.05);死亡组患者IL-6、CRP、PCT水平及APACHE-Ⅱ评分随时间推移均呈显著增高趋势,各指标3个时间点整体比较,差异均有统计学意义(F=65.059、549.720、1190.989、173.083,P<0.05);存活组各时间点IL-6、CRP、PCT水平及APACHE-Ⅱ评分均低于死亡组,差异均有统计学意义(IL-6:t=-4.294、-13.414、-35.499,P<0.05;CRP:t=-10.599、-37.678、-79.754,P<0.05;PCT:t=-28.501、-4Objective To investigate the distribution characteristics of pathogenic bacteria in elderly patients with severe septic shock and the relationship between the state of cardiac function,the change trend of inflammatory factors and the condition of the disease.Methods A total of 96 elderly patients with severe septic shock who were admitted to Beijing Shijitan Hospital,Capital Medical University from June 2017 to June 2019 were selected as the research objects.According to the prognosis of the patients,they were divided into survival group(n=66)and death group(n=30).Collected and identified the pathogenic bacteria of the patients;detected the cardiac function indicators such as left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),and calculated left ventricular ejection fraction(LVEF)after admission.Enzyme-linked immunosorbent assay was used to detect the levels of interlukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)in the two groups were collected immediately after admission,6 and 24 hours after admission.Acute physiology and chronic health scoreⅡ(APACHE-Ⅱ)were performed on patients,and Pearson correlation coefficient analysis was performed on the levels of inflammatory factors IL-6,CRP,PCT and APACHE-Ⅱ.Data were compared with t test,chi-square test or Fisher exact probability method.Results A total of 111 strains of pathogenic bacteria were isolated from 96 patients,of which 76 were gram-negative bacteria,accounting for 68.47%,with 27 strains(24.32%)dominated by E.coli;while 32 gram-positive bacteria accounted for 28.83%,with 17 strains by Staphylococcus aureus(15.31%);3 strains were fungus,accounted for 2.7%.The cardiac function indexes LVESD(40.87±2.04)mm and LVEDD(51.56±1.97)mm of survival group were significantly lower than those of the death group[(42.88±1.77)and(53.78±1.88)mm],and the LVEF 59.54±8.43 was significantly higher than that of the death group(50.33±7.86),the differences between the two groups were statistically significant(t=5.582,5.

关 键 词：老年人 休克 脓毒性 病原菌 心功能 炎性因子 

分 类 号：R459.7[医药卫生—急诊医学]