重症患者肺炎感染病原菌分布情况及其与炎症因子水平、肺部感染评分和血气水平的关系

Distribution of pathogens and its relationship with inflammatory factor level,pulmonary infection score and blood gas level in ICU patients with pneumonia

目的分析重症患者肺炎感染病原菌分布情况及其与炎症因子水平、临床肺部感染评分(clinical pulmonary infection score,CPIS)和血气水平的关系。方法选取北京市大兴区人民医院重症医学科(intensive care unit,ICU)2019年1月至2021年2月间收治的80例ICU肺炎感染患者作为观察组,50例疑似肺部感染ICU患者作为对照组。对患者行肺部病原菌检测、炎症因子及血气水平检测,并调查肺部感染程度。利用Spearman相关性检验分析肺炎感染与炎症因子水平、CPIS和血气水平的关系。结果观察组革兰氏阳性菌的感染率低于真菌感染和革兰氏阴性菌,其中革兰氏阴性菌感染率最高,进一步分析发现,肺炎克雷伯菌感染率最高,约为25.00%,其次为铜绿假单胞菌约为20.00%;观察组血中白介素6(interleukin,IL-6)、IL-18、CIPS及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平明显高于对照组,且差异有统计学意义(P<0.05);观察组动脉血中氧饱和度(arterial oxygen saturation,SaO_(2))、氧分压(arterial partial pressure of O_(2),PaO_(2))水平明显低于对照组,二氧化碳分压(arterial partial pressure of CO_(2),PaCO_(2))水平明显高于对照组,且差异有统计学意义(P<0.05);ICU患者肺炎感染与IL-6、IL-18、TNF-α、CPI评分、PaCO_(2)呈明显正相关关系,与SaO_(2)、PaO_(2)呈显著负相关关系,且差异有统计学意义(P<0.05)。结论ICU肺炎感染患者中革兰氏阴性菌感染率最高,患者体内炎症因子水平、CPIS及血气水平处于显著异常状态,且ICU患者肺炎感染与IL-6、IL-18、TNF-α、CPIS、PaCO_(2)呈明显正相关关系,与SaO_(2)、PaO_(2)呈显著负相关关系。

Objective To analyze the distribution of pathogens and its relationship with the inflammatory factors level,pulmonary infection score and blood gas level in ICU patients with pneumonia.Method A total of 80 ICU patients with pneumonia from January 2019 to February 2021 in Beijing Daxing District People's Hospital were selected as the observational group and 50 ICU patients with suspected pulmonary infection were enrolled as the control group.Pulmonary pathogens,inflammatory factors and blood gas levels were detected and the clinical pulmonary infection score(CPIS)was investigated.Spearman correlation test was used to analyze the relationship between pneumonia infection and inflammatory factor level,CPIS and blood gas level.Result In the observational group,the infective rate of Gram-positive bacteria was lower than that of fungal infection and Gram-negative bacteria.Gram-negative bacteria had the highest infective rate.Further analysis found that Klebsiella pneumoniae was most common,which accounted for 25.00%,followed by pseudomonas aeruginosa(20.00%).Serum level of interleukin-6(IL-6),IL-18,tumor necrosis factor-α(TNF-α)and CPIS in observational group was significantly higher than that in the control group(P<0.05).Compared with the control group,the levels of arterial oxygen saturation(SaO_(2))and arterial partial pressure of O_(2)(PaO_(2))in the observational group were significantly lower,while the level of arterial partial pressure of CO_(2)(PaCO_(2))was significantly higher(P<0.05).IL-6,IL-18,TNF-α,CPIS,PaCO_(2) were positively correlated with pneumonia infection(P<0.05)and negatively correlated with SaO_(2) and PaO_(2)(P<0.05)in ICU patients.Conclusion Among the ICU patients with pneumonia,the infective rate of Gram-negative bacteria is the highest.The level of inflammatory factors,CPIS and arterial blood gas results are remarkably abnormal.The pneumonia infection in ICU is positively related to serum level of IL-6,IL-18 and TNF-α,CPIS,PaCO_(2) and negatively correlated with SaO_(2),PaO_(2).