呼吸机相关性肺炎患者感染病原菌分布与降钙素原和C-反应蛋白及乳酸变化的研究

Distribution of pathogens causing infections in patients with ventilator-associated pneumonia,changes of procalcitonin,C-reactive protein,and lactic acid

目的研究呼吸机相关性肺炎患者病原菌分布情况,并对患者降钙素原(PCT)、C-反应蛋白(CRP)和乳酸水平进行检测,为临床诊断和治疗提供参考,并讨论呼吸机相关性肺炎的预防对策。方法选择2015年1月-2016年1月医院确诊并治疗的103例呼吸机相关性肺炎患者为感染组,根据患者疾病预后分为好转组(54例)和恶化组(49例);并分别选择同期于医院进行呼吸机治疗未合并感染的112名患者为未感染组,选择进行健康体检的98例患者为健康组;对感染组患者进行病原菌分布情况分析,同时对所有对象进行CRP、PCT和乳酸水平的检测。结果感染组患者中共分离出病原菌118株,革兰阴性菌和革兰阳性菌构成比分别为57.63%和41.53%;感染组患者CRP和PCT水平均明显高于未感染组和健康组(P<0.05),感染组中病情好转患者CRP和PCI水平明显低于恶化组(P<0.05),好转组患者在进行插管治疗后各时间点的乳酸水平均明显低于恶化组(P<0.05)。结论呼吸机相关性肺炎患者病原菌分布以革兰阴性菌为主,且患者PCT、CRP和乳酸水平均明显升高。

OBJECTIVE To observe the distribution of pathogens causing infection in patients with ventilator-associated pneumonia （VAP） and detect the level of procalcitonin （PCT）, C-reactive protein （CRP）, and lactic acid so as to provide guidance for clinical diagnosis and treatment and put forward the prevention countermeasures for VAP. METHODS A total of 103 patients who were diagnosed with VAP and treated in the hospital from Jan 2015 to Jan 2016 were chosen as the infection group and divided into the improved group with 54 cases and the exacerba- tion group with 49 cases, meanwhile, 112 patients who were treated with ventilators but were not complicated with infections were set as the non-infection group, and 98 patients who received the physical examination were as- signed as the healthy group. The distribution of the pathogens isolated from the patients with infections was ob- served, and the levels of CRP, PCT, and lactic acid of all the study objects were detected. RESULTS Totally 118 strains of pathogens were isolated from the patients in the infection group, of which 57.63% were gram-negative bacteria, and 41.53% were gram-positive bacteria. The levels of CRP and PCT of the infection group were signifi- cantly higher than those of the non-infection group and the healthy group （P〈0.05）. Among the patients with in- fections, the levels of CRP and PCI of the improved group were significantly lower than those of the exacerbation group （P〈0.05）, and the level of lactic acid of the improve group was remarkably lower than that of the exacerbation group after intubation for different time periods （P〈0.05）. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the patients with VAP, and the levels of PCT, CRP, and lactic acid of the patients are remarkably elevated.