肺部感染对重症急性胰腺炎患者呼吸功能及外周血炎症因子的影响

Influence of pulmonary infection on respiratory function and peripheral blood inflammatory factors of patients with severe acute pancreatitis

目的对重症急性胰腺炎伴有肺部感染患者病原菌分布进行分析,观察患者感染后肺部功能的变化,并探讨炎性因子在肺部感染的重症急性胰腺炎患者中的水平,为临床诊疗提供参考。方法分析2014年6月-2016年6月在医院接受就诊的重症胰腺炎患者的临床资料,依据患者是否并发感染将患者分为感染组64例及非感染组76例,同时纳入同期80例健康体检者为对照组,对病原菌进行鉴定分型,分析患者感染后肺功能的变化,并比较各组外周血炎症指标。结果 64例感染组患者共分离病原菌92株,其中革兰阴性菌52株占56.52%,革兰阳性菌36株占39.13%,真菌4株占4.35%;感染组患者的用力肺活量(FVC)、用力呼气容积(FEV1)、FEV1%及FEV1/FVC肺通气功能与未感染组及对照组相比差异有统计学意义(P<0.05);感染组患者动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、肺一氧化碳弥散量(DLCO)及单位肺泡容积的一氧化碳弥散量(DLCO/VA)指标与未感染组及对照组比较差异有统计学意义(P<0.05);感染组患者外周血C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白介素-6(IL-6)及降钙素原(PCT)水平均高于未感染组及对照组,差异有统计学意义(P<0.05)。结论肺部感染的重症急性胰腺炎患者以革兰阴性菌感染为主,且感染后患者肺功能受到明显影响;肺部感染患者TNF-α、CRP、PCT及IL-6水平较高,对重症急性胰腺炎患者进行TNF-α、CRP、PCT及IL-6检测具有重要价值。

OBJECTIVE To investigate the distribution of pathogens isolated from severe acute pancreatitis patients complicated with pulmonary infection,observe the change of lung function of the patients with the infection,and explore the levels of inflammatory factors of the severe acute pancreatitis patients with pulmonary infections so as to provide guidance for clinical diagnosis and treatment.METHODS The patients with severe pancreatitis who were treated in the hospital from Jun 2014 to Jun 2016 were enrolled in the study,the clinical data of the enrolled patients were analyzed,the patients were divided into the infection group with 64 cases and the non-infection group with 76 cases according to the status of complication with infection,meanwhile,80 healthy people who received physical examination were included and set as the control group.The isolated pathogens were identified and classified,the change of lung function was analyzed,and the levels of peripheral blood inflammatory factors were observed and compared among the three groups.RESULTS A total of 92 strains of pathogens were isolated from 64 patients in the infection group,of which 52（56.52%）were gram-negative bacteria,36（39.13%）were gram-positive bacteria,and 4（4.35%）were fungi.There was significant difference in the forced vital capacity（FVC）,forced expiratory volume（FEV1）,FEV1%,or FEV1/FVC pulmonary ventilation function among the infection group and the non-infection group and the control group（P〈0.05）.There was significant difference in the partial pressure of arterial oxygen（PaO2）,partial pressure of arterial carbon dioxide（PaCO2）in arterial blood,diffusing capacity of the lung for carbon monoxide（DLCO）,or DLCO/VA between the infection group and the non-infection group and the control group（P〈0.05）.The levels of peripheral blood C-reactive protein（CRP）,tumor necrosis factor（TNF-α）,interleukin-6（IL-6）,and procalcitonin（PCT）of the infection group were significantly higher than those of the non-infection group and the control group（P〈0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the pulmonary infection in the patients with severe acute pancreatitis,and the lung function of the patients with the infection is remarkably influenced.The levels of TNF-α,CRP,PCT,and IL-6of the patients with the pulmonary infection are relatively high,and it is of great value to detect the TNF-α,CRP,PCT,and IL-6for the patients with severe acute pancreatitis.