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：王磊 梁立杰 陈红霞 Wang Lei;Liang Li-jie;Chen Hong-xia(Department of respiratory and critical care medicine,Tangshan Hongci Hospital,Tangshan 063000,China;Department of respiratory medicine,Affiliated Hospital of North China University of technology,Tangshan 063000,China;Department of general internal medicine,Tangshan Hongci hospital,Tangshan 063000,China)

机构地区：[1]唐山市弘慈医院呼吸与危重症医学科,唐山063000 [2]华北理工大学附属医院呼吸内科,唐山063000 [3]唐山弘慈医院综合内科,唐山063000

出　　处：《湖南师范大学学报（医学版）》2022年第1期141-144,共4页Journal of Hunan Normal University(Medical Sciences)

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的变化情况,为临床患者临床的诊断与治疗提供依据。方法:选择2017年6月~2018年6月我院接诊的105例患者作为研究对象。按照是否合并重症院内感染性肺炎,将患者分为研究组和对照组。对患者的应激状况[超氧化物歧化酶(SOD)、丙二醛(MDA)及氧化低密度脂蛋白(Ox-LDL)]及炎症指标[肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、脑钠肽(BNP)、C反应蛋白(CRP)及降钙素原(PCT)]进行检测,并对患者病原菌及耐药状况进行分析。结果:研究组SOD水平明显高于对照组患者,MDA及Ox-LDL水平明显低于对照组患者,差异有统计学意义。研究组的TNF-α、IL-6、BNP、CRP及PCT水平均明显高于对照组。45例院内感染患者,共分离出56株病原菌,G^(+)菌23株,占41.07%,其中肠球菌最多,12株,占21.43%。G^(-)菌33株,占58.93%,其中大肠埃希菌最多,占28.57%,其次是肺炎克雷伯菌,占14.29%。G^(+)菌对于克林霉素、青霉素等存在普遍耐药,金黄色葡萄球菌和肠球菌对于青霉素G的耐药率为75.00%、100.00%;对克林霉素的耐药率83.33%、100.00%;但是对于利福平、万古霉素、替考拉宁有较高敏感性与较低的耐药率。G^(-)菌对喹诺酮类药物、第三代头孢菌素、氨基糖苷类药物有较高的耐药性。肺炎克雷伯菌、铜绿假单胞菌及鲍曼不动杆菌对链霉素的耐药率均高达100%,铜绿假单胞菌及鲍曼不动杆菌对环丙沙星的耐药率也较高。但是对于亚胺培南、美罗培南、阿米卡星及头孢哌酮舒巴坦仍较为敏感。结论:慢性心力衰竭合并重症院内感染性肺炎患者的应激反应状与炎症指标水平均会出现较为明显的波动。分离的菌株主要为革兰氏阴性菌,亚胺培南、阿米卡星、美罗培南、头孢哌酮舒巴坦等药物在治疗方面均存在较高的敏感,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 pathogenic bacteria and drug resistance of patients.Methods 105 cases patients with chronic heart failure from June 2017 to June 2018 were selected for the study.Patients were divided into study group and control 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 inflammatory indicators[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),brain natriuretic peptide(BNP),C-reactive protein(CRP)and procalcitonin(PCT)]were detected,and pathogenic bacteria and drug resistance were analyzed.Results The SOD level of the study group was significantly higher than that of the control group,and the levels of MDA and Ox-LDL were significantly lower than those of the control group.The levels of TNF-α,IL-6,BNP,CRP and PCT in the study group were significantly higher than those in the control group.Among 45 patients with nosocomial infection,56 strains of pathogenic bacteria were isolated,23 strains of G^(+)bacteria accounted for 41.07%.Among them,12 strains of Enterococcus accounted for 21.43%.Thirty-three strains of G^(-)bacteria accounted for 58.93%.Escherichia coli accounted for 28.57%,followed by Klebsiella pneumoniae,accounting for 14.29%.G^(+)bacteria are generally resistant to clindamycin and penicillin.Staphylococcus aureus and Enterococcus are 75.00%and 100.00%resistant to penicillin G,83.33%and 100.00%resistant to clindamycin,but they are still sensitive to vancomycin,rifampicin and teicoplanin,and the resistance rate is low.G^(-)bacteria are more resistant to quinolones,aminoglycosides and third-generation cephalosporins.The resistance rates of Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii to streptomycin were all as high as 100%.The resistance rates of Pseudomonas aeruginos

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]