急性脑出血全麻患者术后感染病原菌分析

Distribution of pathogens causing postoperative infections in acute intracerebral hemorrhage patients undergoing general anesthesia

目的研究急性脑出血全麻患者术后感染病原菌分布及对患者认知功能的影响,为临床治疗提供参考。方法选取医院2012年9月-2014年9月诊治的170例急性脑出血全麻术后感染患者为感染组,分析病原菌分布;以医院同期170名健康体检者为对照组,急性脑出血全麻术后未感染患者170例设为未感染组,比较3组受试者认知功能及血清中成纤维细胞生长因子和炎症因子水平的变化。结果 170例感染患者中共分离病原菌170株,其中革兰阳性菌77株占45.3%,主要为金黄色葡萄球菌18株占10.6%、腐生葡萄球菌12株占7.1%、粪肠球菌11株占6.5%;革兰阴性菌93株占54.7%,其中铜绿假单胞菌18株占10.6%、产气肠杆菌17株占10.0%、脑膜炎奈瑟菌16株占9.4%;感染患者MMSE评分明显降低,且血清过氧化氢酶和超氧化物歧化酶水平明显低于对照组和未感染组,而丙二醛、白细胞介素-2、白细胞介素-10及肿瘤坏死因子-α水平明显升高,差异有统计学意义(P<0.05)。结论急性脑出血全麻患者容易并发病原菌感染,且感染明显影响患者的认知功能评分。

OBJECTIVE To analyze the pathogen distribution and its effect on recognition function in acute intracerebral hemorrhage patients with general anesthesia,so as to provide reference for clinical treatment.METHODS A total of 170 cases of patients got infections after general anesthesia operation for the acute intracerebral hemorrhage in our hospital from Sep.2012 to Sep.2014 were enrolled as infected group.Another 170 cases of healthy subjects at the same period in our hospital were taken as control group.And another 170 cases of uninfected patients after general anesthesia operation for acute intracerebral hemorrhage were taken as uninfected group.The changes of recognition function,serum fibroblast growth factor and inflammatory factors were compared in these three groups.RESULTS A total of 170 strains of pathogens were isolated from the 170 cases of patients,including 77（45.3%）strains of gram-positive bacteria,mainly Staphylococcus aureus 18（10.6%）strains,Staphylococcus saprophyticus 12（7.1%）strains,and Enterococcus faecalis 11（6.5%）strains.There were 93（54.7%）strains of gram-negative bacteria,including Pseudomonas aeruginosa 18（10.6%）strains,Enterobacter aerogenes 17（10.0%）strains,and Neisseria meningitides 16（9.4%）strains.The MMSE scores of infected patients were decreased obviously,and catalase and superoxide dismutase in serum were lower than control group and uninfected group obviously,but MDA,IL2,IL10 and TNF-αwere increased significantly compared with control and uninfected groups（P〈0.05）.CONCLUSIONThere is big chance for acute intracerebral hemorrhage patients got infected,and which could influence the cognition function of patients.