老年重症胰腺炎病人腹腔感染的病原菌分布、危险因素及相关炎症因子分析

Distribution of pathogens,risk factors and the levels of related cytokines in the elderly patients with severe pancreatitis complicated with abdominal infections

目的考察老年重症胰腺炎病人腹腔感染的病原菌分布特点、危险因素及相关炎症因子水平。方法选取我院90例老年重症胰腺炎病人(对照组)与90例老年重症胰腺炎伴腹腔感染病人(感染组),检测并分析病原菌分布特点,判别其危险因素,同时测定2组血清IL-1、IL-6、IL-8、TNF-α相关炎症因子水平。结果 90例感染组病人共检出病原菌152株,其中革兰阳性菌89株(58. 55%),以金黄色葡萄球菌(38. 81%)和表皮葡萄球菌(13. 82%)为主;革兰阴性菌56株(36. 84%),以铜绿假单胞菌(17. 76%)和大肠埃希菌(10. 53%)为主。其禁食时间>20 h、肠功能异常>6 d、低氧血症及APACHEⅡ评分>11分均为腹腔感染的危险因素,同时感染组血清IL-1、IL-6、IL-8和TNF-α的表达水平均显著高于对照组(P<0. 01或0. 05)。结论重症胰腺炎病人腹腔感染的病原菌主要为革兰阳性菌,病人的禁食时间、肠功能异常时间、低氧血症以及APACHEⅡ评分过高,均会影响腹腔感染的发生。

Objective To investigate the distribution of pathogens,risk factors and the levels of related cytokines in the elderly patients with severe pancreatitis complicated with abdominal infections.Methods Ninety elderly patients with severe acute pancreatitis( control group) and ninety elderly patients with severe pancreatitis complicated with abdominal infection( infection group) were enrolled in this study. The distribution characteristics of pathogens were detected and analyzed,and the risk factors were determined. The serum levels of interleukin( IL)-1,IL-6,IL-8,and tumor necrosis factor( TNF)-α were detected. Results A total of 152 strains of pathogens were detected in the infection group,including 89 strains( 58. 55%) of gram-positive bacteria,including Staphylococcus aureus( 38. 81%) and Staphylococcus epidermidis( 13. 82%),and 56 strains of gram-negative bacteria( 36. 84%),including Pseudomonas aeruginosa( 17. 76%) and Escherichia coli( 10. 53%). The fasting time > 20 h,duration of intestinal dysfunction > 6 d,hypoxemia and APACHE-Ⅱ score>11 were the risk factors of abdominal infection in the elderly patients with severe pancreatitis. Meanwhile the serum levels of IL-1,IL-6,IL-8 and TNF-α in the infection group were significantly higher than those in the control group( P < 0. 01 or 0. 05). Conclusions The main pathogens of abdominal infection in the elderly patients with severe pancreatitis are gram-positive bacteria,and the fasting time,intestinal dysfunction,hypoxemia and APACHE-Ⅱ score could affect the abdominal infection.