急性重症创伤感染病原菌分布和凝血功能变化  

Pathogens isolated from acute severe trauma patients with infection and changes of coagulation function indexes

作　　者：葛新 徐策 宦陟榕 姚浩 蔡济民 GE Xin;XU Ce;HUAN Zhi-rong;YAO Hao;CAI Ji-min(Wuxi Ninth People's Hospital Affiliated to Soochow University,Wuxi,Jiangsu 214000,China)

机构地区：[1]苏州大学附属无锡九院重症医学科,江苏无锡214000

出　　处：《中华医院感染学杂志》2022年第17期2619-2623,共5页Chinese Journal of Nosocomiology

基　　金：无锡市卫健委精准医学重点专项基金资助项目(J202007);无锡市卫健委科研重大基金资助项目(Z202105)。

摘　　要：目的探究急性重症创伤后感染患者病原菌分布及其凝血功能临床意义。方法选择2016年10月-2020年10月苏州大学附属无锡九院收治的113例急性重症创伤后感染患者为研究对象,分析患者感染病原菌分布及其耐药性,测定凝血功能指标并分析其临床意义。结果113例患者共检出病原菌124株,其中革兰阴性菌、革兰阳性菌、真菌占比分别为50.81%、41.94%、7.26%;鲍氏不动杆菌对头孢唑林、头孢噻肟等耐药率较高,肺炎克雷伯菌对头孢唑林、头孢噻肟等耐药率高,溶血葡萄球菌对青霉素、苯唑西林耐药率高;患者28 d预后不良发生率为22.12%,预后良好组患者凝血酶原时间(PT)、D-二聚体(D-D)、活化部分凝血活酶时间(APTT)均低于预后不良组,纤维蛋白原(FIB)高于预后不良组(P<0.05);受试者工作特征曲线(ROC)结果显示,PT、FIB、D-D、APTT预测患者28 d预后的曲线下面积(AUC)分别为0.800、0.794、0.824、0.826。结论急性重症创伤后感染病原菌主要为革兰阴性菌,耐药情况严重,患者体内存在严重凝血功能异常。OBJECTIVE To explore the distribution of pathogens isolated from acute severe trauma patients with infection and analyze the clinical significance of coagulation function indexes.METHODS A total of 113 acute severe trauma patients with infection who were treated in Wuxi Ninth People′s Hospital Affiliated to Suzhou University from Oct 2016 to Oct 2020 were recruited as the study objects.The distribution of pathogens and drug resistance were observed,the coagulation function indexes were detected,and the clinical significance was analyzed.RESULTS Totally 124 strains of pathogens were isolated from the 113 patients,50.81%of which were gram-negative bacteria,41.94%were gram-positive bacteria,and 7.26%were fungi.The drug resistance rates of Acinetobacter baumannii to cefazolin and cefotaxime were high,the drug resistance rates of Klebsiella pneumoniae to cefazolin and cefotaxime were high,and the drug resistance rates of Staphylococcus haemolyticus to penicillin and oxacillin were high.The incidence of 28-day poor prognosis was 22.12%.The prothrombin time(PT),D-dimer(D-D)and activated partial thromboplastin time(APTT)of the favorable prognosis group were significantly lower than those of the poor prognosis group,while the fibrinogen(FIB)level of the favorable prognosis group was significantly higher than that of the poor prognosis group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under curves(AUCs)of PT,FIB,D-D and APTT were respectively 0.800,0.794,0.824 and 0.826 in prediction of 28-day prognosis.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the acute severe trauma patients with infection and are highly resistant to drugs,and the patients show severe abnormal coagulation function.

关 键 词：急性重症创伤后感染 病原菌分布 凝血功能 临床意义 

分 类 号：R641[医药卫生—外科学]