慢性阻塞性肺疾病急性加重期合并肺部感染病原学及其预后评估

Etiological characteristics of pulmonary infection in acute exacerbation of chronic obstructive pulmonary disease patients and assessment of prognosis

目的探究慢性阻塞性肺疾病急性加重期(AECOPD)合并肺部感染病原学特点及急性生理学及慢性健康状况评分(APACHEⅡ)、氧合指数对患者预后的评估价值.方法回顾性分析郑州大学第五附属医院2016年7月-2017年7月收治的180例AECOPD合并肺部感染患者的临床资料,对痰培养分离出的病原菌菌株进行鉴定和药敏试验,根据预后情况将患者分为死亡组和好转组,利用受试者工作特征曲线(ROC)评估APACHEⅡ评分、氧合指数评估患者预后的价值.结果180例AECOPD合并肺部感染患者痰样本中共检出病原菌194株,革兰阴性菌109株占56.19%,革兰阳性菌47株占24.23%,真菌38株占19.59%;主要革兰阴性菌肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星敏感,鲍氏不动杆菌对替加环素敏感,铜绿假单胞菌对阿米卡星敏感,主要革兰阳性菌金黄色葡萄球菌对万古霉素、替考拉宁、利奈唑胺敏感;180例患者中有92例患者死亡,死亡组患者的APACHEⅡ评分、PaCO_(2)显著高于好转组,氧合指数、PaO_(2)显著低于好转组,差异有统计学意义(P<0.05);ROC结果显示:APACHEⅡ评分、氧合指数预测患者预后的AUC分别为0.834、0.773,均具有较高的评估价值.结论AECOPD合并肺部感染病原菌以革兰阴性菌为主,同时应警惕真菌感染,APACHEⅡ评分、氧合指数对患者预后均具有较好的预测价值,合理选择抗菌药物对改善病情有积极意义.

OBJECTIVE To explore the etiological characteristics of pulmonary infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and analyze the value of acute physiology and chronic health evaluationⅡ(APACHEⅡ)and oxygenation indexes(OI)in evaluation of prognosis of the patients.METHODS The clinical data of 180 AECOPD patients complicated with pulmonary infection who were treated in the Fifth Affiliated Hospital of Zhengzhou University from Jul 2016 to Jul 2017 were retrospectively analyzed.The pathogens isolated from sputum specimens were identified,the drug susceptibility testing was performed.The patients were divided into the death group and the improvement group according to the treatment outcomes,and the value of APACHEⅡscore and oxygenation indexes in assessment of prognosis was analyzed by using receiver operating characteristic(ROC)curve.RESULTS A total of 194 strains of pathogens were isolated from sputum specimens of 180 AECOPD patients complicated with pulmonary infection,109(56.19%)of which were gram-negative bacteria,47(24.23%)were gram-positive bacteria,and 38(19.59%)were fungi.Among the major species of gram-negative bacteria,Klebsiella pneumoniae strains were susceptible to imipenem,meropenem and amikacin,Acinetobacter baumannii strains were susceptible to tigecycline,and Pseudomonas aeruginosa strains were susceptible to amikacin.Among the major species of gram-positive bacteria,Staphylococcus aureus strains were susceptible to vancomycin,teicoplanin and linezolid.Among the 180 patients,92 died.The APACHEⅡscore and PaCO_(2) of the death group were significantly higher than those of the improvement group,the oxygenation indexes and PaO_(2) of the death group were significantly lower than those of the improvement group(P<0.05).The result of ROC curve analysis showed that the AUCs of APACHEⅡscore and oxygenation indexes were respectively 0.834 and 0.773 in prediction of prognosis of the patients,both had high predictive value.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the AECOPD patients complicated with pulmonary infection,and attention should be also paid to the fungal infection.Both APACHEⅡscore and oxygenation indexes have high value in prediction of prognosis,and reasonable use of antibiotics has positive significance in improvement of illness condition.