心外科患者术后病原菌感染与对心肌酶影响研究

Distribution of pathogens causing postoperative infections in patients of cardiac surgery department and effect on myocardial enzyme

目的对医院心外科术后患者病原菌分布及对心肌酶影响进行研究,为临床治疗提供借鉴。方法对2010年4月-2014年4月诊治的心外科手术患者1 200例的临床资料进行回顾性分析,其中感染组患者284例、未感染组患者916例,选同期健康体检者180名为对照组,采用全自动微生物鉴定仪对病原菌进行鉴定,酶联免疫吸附测定法分析血清中表皮生长因子(EGF)及缺氧诱导因子ɑ(HIFɑ)及肿瘤坏死因子ɑ(TNFɑ),并检测血清中心肌酶水平;采用WHONE5.5和SPSS20.0软件对数据进行统计分析。结果共分离病原菌284株,其中革兰阳性菌101株占35.6%,以金黄色葡萄球菌、G型溶血性链球菌、酿脓链球菌为主,革兰阴性菌183株占64.4%,以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主;患者术后血清心肌酶水平明显升高,与对照组差异有统计学意义(P<0.05);感染组血清心肌酶水平明显高于未感染组患者,差异有统计学意义(P<0.05);患者术后血清EGF、HIFɑ及TNFɑ水平明显升高,与对照组比较差异有统计学意义(P<0.05);感染组血清上述分子水平明显高于未感染组患者,差异有统计学意义(P<0.05)。结论心外科手术后患者容易受到病原菌感染,感染后患者心肌酶水平异常可能与感染引起的EGF、HIFɑ及TNFɑ异常有关。

OBJECTIVE To explore the distribution of pathogens causing postoperative infections in the patients of cardiac surgery department and observe the effect on the myocardial enzyme so as to provide guidance for clinical treatment.METHODS The clinical data of 1 200 patients who underwent cardiac surgical procedures from Apr 2010 to Apr 2014 were retrospectively analyzed;totally 284 patients with infections were assigned as the infection group,and 916 patients without infections were set as the non-infection group;180healthy people who received the physical examination during the same period were chosen as the control group.The pathogens were identified by using automatic microorganism identification system,the serum vascular epidermal growth factor（EGF）,hypoxia-inducible factorɑ（HIFɑ）,and tumor necrosis factorɑ（TNFɑ）were analyzed by means of enzyme-linked immunosorbent assay,the level of serum myocardial enzyme was determined,and the statistical analysis of data was performed with the use of WHONET5.5software and SPSS20.0software.RESULTS A total of 284 strains of pathogens were isolated,including 101（35.6%）strains of gram-positive bacteria and 183（64.4%）strains of gram-negative bacteria.The Staphylococcus aureus,type G Streptococcus hemolyticus,and Streptococcus pyogenes were dominant among the gram-positive bacteria;the Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa were the predominant species of gram-negative bacteria.The level of serum myocardial enzyme of the infection group was significantly higher than that of the non-infection group（P〈0.05）.The levels of serum EGF,HIFɑ,and TNFɑof the patients were remarkably elevated after the surgery,as compared with the control group（P〈0.05）;the levels of the above indicators of the infection group were significantly higher than those of the non-infection group（P〈0.05）.CONCLUSION The patients undergoing the cardiac surgical procedures are prone to be infected with the pathogens,and the abnormal level of the myocardial enzyme may be associated with abnormal EGF,HIFɑor TNFɑinduced by the infection.