摘要
目的探讨呼吸机相关性肺炎患者血清白细胞介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(Tumor necrosis factor,TNF-α),单核细胞趋化蛋白1(Monocyte chemotactic protein 1,MCP-1)的水平变化。方法采用回顾性调查方法,分析2018年6月-2019年6月某三级甲等综合医院收治的186例进行呼吸机治疗的患者临床资料,其中合并呼吸机相关性肺炎(Ventilatorassociatelpeneumonia,VAP)患者96例,作为感染组,未合并VAP患者90例,作为未感染组。比较两组患者血清IL-8,TNF-α,MCP-1水平差异,分析VAP患者感染病原学特点,单因素及多因素Logistic回归分析患者发生VAP的危险因素。结果 96例VAP患者共分离出102株病原菌,革兰阴性菌71株,占69.61%,以大肠埃希菌、鲍氏不动杆菌、肺炎克雷伯菌为主;革兰阳性菌22株,占21.57%,以金黄色葡萄球菌为主;真菌9株,占8.82%。感染组患者IL-8、TNF-α和MCP-1水平分别为(35.46±3.15)ng/L、(5.03±0.58)ng/L和(514.24±56.87)ng/L,较未感染组患者均显著升高(P<0.05)。多因素Logistic回归分析结果,年龄≥60岁、机械通气时间≥7 d、气管切开、合并低蛋白血症、联用抗菌药物、侵入性操作、住院时间≥15 d是发生VAP医院感染的独立危险因素(P<0.05)。结论 VAP患者感染病原菌以革兰阴性菌为主,临床治疗应选择合理的抗菌药物;血清IL-8,TNF-α,MCP-1水平显著升高,应针对危险因素预防VAP的发生。
OBJECTIVE To explore the changes of serum interleukin-8(IL-8),tumor necrosis factor(TNF-α),monocyte chemotactic protein 1(MCP-1)in patients with ventilator-associated pneumonia(VAP).METHODS A retrospective survey was conducted for the clinical data of 186 patients who were treated with ventilators in tertiary a three-A general hospital from Jun 2018 to Jun 2019,96 patients who were complicated with VAP were assigned as the infection group,and 90 patients who were not complicated with VAP were set as the non-infection group.The levels of serum IL-8,TNF-αand MCP-1 were compared between the two groups of patients,the etiological characteristics of VAP were analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the risk factors for VAP.RESULTS A total of 102 strains of pathogens were isolated from the 96 patients with VAP,71(69.61%)of which were gram-negative bacteria,22(21.57%)were gram-positive bacteria,and 9(8.82%)were fungi;Escherichia coli,Acinetobacter baumannii and Klebsiella pneumoniae were dominant among the gram-negative bacteria;Staphylococcus aureus was the predominant species of the gram-positive bacteria.The levels of IL-8,TNF-αand MCP-1 of the infection group were respectively(35.46±3.15)ng/L,(5.03±0.58)ng/L and(514.24±56.87)ng/L,significantly higher than those of the non-infection group(P<0.05).Multivariate logistic regression analysis showed that the no less than 60 years of age,mechanical ventilation duration no less than 7 days,tracheotomy,complication with hypoproteinemia,combined use of antibiotics,invasive procedures and length of hospital no less than 15 days were the independent risk factors for the VAP(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the patients with VAP,and it is necessary for the hospital to reasonably use antibiotics.The levels of serum IL-8,TNF-αand MCP-1 are remarkably elevated,and it is necessary to take targeted prevention measures for VAP according to the risk factors.
作者
徐晓耘
袁咏梅
陈晓君
许波银
陈红
XU Xiao-yun;YUAN Yong-mei;CHEN Xiao-jun;XU Bo-yin;CHEN Hong(Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2020年第17期2624-2627,共4页
Chinese Journal of Nosocomiology
基金
江苏省卫生计生委医学科研基金资助项目(H2018077)。
