胸外科患者术后医院肺部感染影响因素和痰热清辅助治疗效果

Influencing factors of nosocomial pulmonary infection and the effect of assisted treatment of sputum and heat clearing and inflammation regulation in patients undergoing thoracic surgery

目的研究胸外科患者术后医院肺部感染的影响因素和痰热清辅助治疗效果与炎症调控的价值。方法选取2017年12月-2019年3月濮阳市油田总医院胸外科手术患者729例为研究对象,统计患者术后医院肺部感染情况,归纳胸外科患者术后医院肺部感染的影响因素。按照1∶1将肺部感染患者纳入研究组和对照组,各34例;两组患者均选取同样抗菌药物,研究组同时辅助痰热清注射液治疗。检测两组患者感染明确时(T1)、抗感染治疗7 d(T2)和抗感染治疗14 d(T3)时炎症因子[C-反应蛋白(C-reactive protein,CRP)、白细胞介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]水平。结果发生医院肺部感染患者68例,感染率为9.33%。长期吸烟史、术前肺功能、手术时间、术中出血量、术中输血是胸外科患者术后医院肺部感染的影响因素(P<0.05)。研究组治疗疗效优于对照组(P=0.046)。T1,T2和T3时,研究组CRP、IL-8、TNF-α分别为(19.50±2.20)mg/L、(8.50±2.01)mg/L、(5.75±1.30)mg/L,(84.60±7.44)pg/ml、(53.40±5.38)pg/ml、(42.10±3.22)pg/ml和(86.50±6.70)ng/ml、(37.40±6.40)ng/ml、(19.80±2.81)ng/ml与对照组比较差异有统计学意义(P<0.05)。结论胸外科患者术后医院肺部感染影响因素多样,并非单一因素所致;除积极防控影响因素外,辅以痰热清注射液有助于减少炎症介质释放、削弱炎症反应,从而遏制感染进展,扭转结局。

OBJECTIVE To investigate the influential factors of nosocomial pulmonary infection in patients after thoracic surgery and the value of adjuvant therapy and inflammation regulation. METHODS A total of 729 patients with thoracic surgery in Puyang Oilfield General Hospital from Dec. 2017 to Mar. 2019 were selected as research subjects. The postoperative pulmonary infections of patients were counted, and the influential factors of the pulmonary infection in patients post thoracic surgery were summarized. The patients with pulmonary infection were divided into observation group and control group according to 1∶1 ratio, 34 cases in each group. The two groups of patients were selected the same antibacterial drugs, and the research group was also treated with Tanreqing injection. The levels of inflammatory factors [C-reactive protein(CRP), interleukin-8, and tumor necrosis factor-α were detected in two groups when the infection was clear(T1), 7 days after anti-infective treatment(T2), and 14 days after anti-infective treatment(T3). RESULTS There were 68 patients with nosocomial pulmonary infection and the infection rate was 9.33%. Long term smoking history, preoperative pulmonary function, operation time, intraoperative blood loss and intraoperative blood transfusion were the influencing factors of nosocomial pulmonary infection in patients after thoracic surgery(P<0.05), and the curative effect of the reearch group was better than that of the control gorup(P=0.046). And the total effective rate of treatment in the study group was 97.06%, significantly higher than that of the control group(82.36%)(P=0.046). At T1, T2 and T3, the levels of CRP, IL-8 and TNF-α in the study group were(19.50±2.20) mg/L,(8.50±2.01)mg/L,(5.75±1.30) mg/L,(84.60±7.44) pg/ml,(53.40±5.38) pg/ml,(42.10±3.22)pg/ml and(86.50±6.70)ng/ml,(37.40±6.40)ng/ml,(19.80±2.81)ng/ml, respectively, significantly lower than those in the control group(P<0.05). CONCLUSION There are various influencing factors of nosocomial pulmonary infection after thoracic surgery, not caused by a single factor. In addition to actively preventing and controlling influencing factors, supplemented with Tanreqing injection can help reduce the release of inflammatory mediators, weaken inflammation response, thereby curbing the progress of infection and reversing the outcome.