急腹症感染性休克患者的病原菌分析及脑钠肽对预后的评估分析

Distribution of pathogens isolated from patients with acute abdomen patients complicated with septic shock and value of brain natriuretic peptide in assessment of prognosis

目的观察分析急腹症感染性休克患者的病原菌分布情况,探讨B型利钠肽(BNP)在急腹症感染性休克患者体内变化水平及对预后的评估价值。方法选择2015年1月-2016年8月于医院住院治疗的67例急腹症伴有感染性休克的患者的研究资料,依据患者治疗4周后死亡情况将患者分为死亡组29例和存活组38例,采用微生物鉴定仪对患者采集的标本进行病原菌鉴定分型;采用受试者工作曲线(ROC)比较血清细胞因子的诊断效能;使用Pearson相关性检验分析患者BNP水平与左室射血分数(LVEF)的相关性。结果 67例患者送检样本共分离出致病菌83株,以革兰阴性菌为主,共65株占78.31%;存活组患者BNP、C-反应蛋白(CRP)、降钙素原(PCT)水平均显著低于死亡组,而LVEF显著高于死亡组(P<0.05);Pearson相关性分析显示,急腹症感染性休克患者的BNP水平与LVEF呈显著负相关关系(r=-0.758,P<0.05)。结论急腹症感染性休克以革兰阴性菌感染为主;BNP水平可以反应患者心脏功能以及对患者的预后有一定的评估价值。

OBJECTIVE To investigate the distribution of pathogens isolated from acute abdomen patients complicated with septic shock and explore the change of brain natriuretic peptide （BNP） level in the patients and its value in assessment of prognosis.METHODS The study data were collected from 67 acute abdomen patients complicated with septic shock who were hospitalized from Jan 2015 to Aug 2016 and were divided into the death group with 29 cases and the survival group with 38 cases according to the status of death after the treatment for 4 weeks.The pathogens isolated from specimens of the patients were identified by using microbial identification system, the diagnostic efficacies of serum cytokines were compared by means of receiver operator characteristic （ROC） curve, and the Pearson correlation test was carried out to analyze the correlation between the BNP level and the left ventricular ejection fraction （LVEF）.RESULTS A total of 83 strains of pathogens were isolated from the submitted specimens of the 67 patients, of which 65 （78.31%） were gram-negative bacteria.The levels of BNP, C-reactive protein （CRP） and procalcitonin （PCT） of the survival group were significantly lower than those of the death group, however, the LVEF of the survival group was significantly higher than that of the death group （P〈0.05）.The Pearson correlation analysis indicated that the BNP level of the acute abdomen patients complicated with septic shock showed significantly negative correlation with the LVEF （r=-0.758,P〈0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the acute abdomen patients complicated with septic shock.The BNP level may reflect the cardiac function of the patients and have cer-tain value in as-sessment of the prognosis of the patients.