外伤性脑出血患者术后感染病原菌分布特点及与炎症反应和氧化应激关系探讨

Distribution of pathogenic bacteria in patients with traumatic cerebral hemorrhage after operation and expression of inflammatory stress index in serum

目的:探讨外伤性脑出血患者术后感染的病原菌情况以及血清炎症反应和氧化应激指标的表达特点。方法:收集150例外伤性脑出血患者,根据术后有无发生感染分为未感染组(n=85)和感染组(n=65),同时选择50例同期健康志愿者作为对照组。收集整理感染组患者感染部位和病原菌的分布情况,同时收集三组受检者空腹静脉血5 ml,分别检测血清肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-2(IL-2)、超氧化物歧化酶(SOD)和丙二醛(MDA)等炎症反应和氧化应激指标水平,并分析其表达特点。结果:感染组术后感染多发生在呼吸道、肺部和颅内等部位,分别占32.31%、23.08%和18.46%。从65份送检样本中共分离病原菌73株,以革兰阴性菌为主,占56.16%,其次是革兰阳性菌、真菌,分别占36.99%、6.85%。感染组血清TNF-α、CRP、PCT、MDA水平均高于未感染组和对照组,同时血清IL-2、SOD水平低于未感染组和对照组,组间比较差异有统计学意义(P<0.05),而未感染组和对照组上述炎症应激指标比较均无统计学差异(P>0.05)。结论:外伤性脑出血患者术后感染的主要病原菌是革兰阴性菌。术后感染的发生可能与炎症反应、氧化应激存在紧密联系。

Objective:To investigate the pathogenic bacteria of postoperative infection in patients with traumatic cerebral hemorrhage and the expression characteristics of serum inflammatory stress indicators.Methods:A total of 150 patients with traumatic cerebral hemorrhage were collected.They were divided into two groups according to whether the postoperative infection occurred:uninfected group(n=85)and infected group(n=65).50 healthy volunteers in the same period were selected as control group.The distribution of infection site and Gram negative/positive identification of pathogenic bacteria in the infected group were collected and sorted out.5 ml of fasting venous blood was collected from the three groups of patients,and the levels of serum tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),procalcitonin(PCT),interleukin-2(IL-2),superoxide dismutase(SOD)and malondialdehyde(MDA)were detected,and their expression characteristics were analyzed.Results:In the infected group,the postoperative infections mainly occurred in respiratory tract,lung and intracranial areas,accounting for 32.31%,23.08%and 18.46%respectively.A total of 73 strains of pathogenic bacteria were isolated from 65 samples,mainly Gram-negative bacteria,accounting for 56.16%,followed by Gram-positive bacteria and fungi,accounting for 36.99%and 6.85%respectively.The levels of serum TNF-α,CRP,PCT and MDA in the infected group were higher than those in the uninfected group and the control group,while the levels of serum IL-2 and SOD were significantly lower than those in the uninfected group and the control group(P<0.05),but there was no significant difference in the above-mentioned inflammatory stress indicators between the uninfected group and the control group(P>0.05).Conclusion:Gram-negative bacteria are the main pathogens of postoperative infection in patients with traumatic cerebral hemorrhage.Postoperative infection may be closely related to inflammatory reaction and oxidative stress.