重症加强护理病房重症感染患者病原菌分布及延长亚胺培南输注时间的疗效观察

Distribution of Pathogenic Bacteria in Patients with Severe Infection in Intensive Care Unit and Effects of Prolonged Imipenem Infusion

目的:分析重症加强护理病房(ICU)重症感染患者病原菌分布情况,并探讨延长亚胺培南输注时间的治疗效果。方法:选取2021年5月~2022年5月本院收治的96例ICU重症感染患者为研究对象,入院后对其进行病原菌的分离与鉴定,分析病原菌的分布情况。依据入院建档单双号分为对照组和观察组,每组48例。两组均采用相同浓度的注射用亚胺培南西司他丁钠进行治疗,对照组给予常规输注时间治疗(30min),观察组给予延长输注时间治疗(3h),两组均连续治疗1周。比较两组治疗前后白细胞介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平,比较两组主要病原菌清除率、临床疗效及不良反应发生率。结果:96例ICU重症感染患者中共检出病原菌126株,包括革兰阴性菌81株(64.29%)、革兰阳性菌41株(32.54%)、真菌4株(3.17%)。其中,革兰阴性菌以铜绿假单胞菌(23株,18.25%)、肺炎克雷伯菌(21株,16.67%)、鲍曼不动杆菌(18株,14.29%)为主;革兰阳性菌以金黄色葡萄球菌(17株,13.49%)、肠球菌属(12株,9.52%)为主;真菌以白假丝酵母菌(4株,3.17%)为主。治疗后两组IL-6、PCT、TNF-α水平均降低,且观察组低于对照组(P<0.05)。观察组的主要病原菌总清除率(93.18%)高于对照组(46.81%,P<0.05)。观察组的治疗总有效率(93.75%)高于对照组(72.92%,χ^(2)=7.500,P<0.05);两组不良反应发生率比较无统计学差异(P>0.05)。结论:ICU重症感染患者病原菌主要以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌等革兰阴性菌以及金黄色葡萄球菌、肠球菌属等革兰阳性菌为主,建议临床治疗ICU重症感染患者时可适当延长亚胺培南输注时间,不仅可有效改善炎症,还能提高对病原菌的清除率,且疗效优于常规时间输注,安全性较高。

Objective:To analyze the distribution of pathogenic bacteria in intensive care unit(ICU)patients with severe infections,and to explore the therapeutic ef fects of prolonged the infusion time of imipenem.Methods:A total of 96 ICU patients with severe infection who were admitted to our hospital from May 2021to May 2022 were selected as observation objects.After admission,pathogenic bacteria was isolated and identified,and the distribution of pathogens was analyzed.96 patients were divided into control group and study group according to the odd and even numbers of the admission files,each group was 48 cases.Both groups were treated with the same concentration of imipenem and cilastatin sodium for injection.The control group was treated with conventional infusion time(30 min),while the observation group was treated with extended infusion time(3h).Both groups were treated continuously for one week.The levels of interleukin-6(IL-6),calcitonin(PCT)and tumor necrosis factor-α(TNF-α)between the two groups before and after treatment were compared,and the main pathogen clearance rate,clinical eff ects and adverse eff ects rate were compared.Results:A total of 126 pathogenic bacteria were detected in 96 ICU patients with severe infection,including 81 gram-negative bacteria(64.29%),41 gram-positive bacteria(32.54%),and 4 fungi(3.17%).Gram-negative bacteria was dominated by Pseudomonas aeruginosa(23,18.25%),Klebsiella pneumoniae(21,16.67%),and Acinetobacter baumannii(18,14.29%);among Gram-positive bacteria,Staphylococcus aureus(17,13.49%)and Enterococcus(12,9.52%)were the main species;the fungi was mainly Candida albicans(4,3.17%).After treatment,the levels of IL-6,PCT and TNF-αwere lower than those before treatment in the two groups,and the study group was significantly lower than that in the control group(P<0.05).The total bacterial clearance rate of the study group was 93.18%,which was significantly higher than that of the control group(46.81%,P<0.05).The total treatment eff ective rate of the study group was 93.75%,which was significantly higher than that of the control group(72.92%,χ^(2)=7.500,P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion:The pathogenic bacteria in ICU patients with severe infection were mainly Gram-negative bacteria such as Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii,and Gram-positive bacteria such as Staphylococcus aureus and Enterococcus.It is suggested that the infusion time of imipenem can be appropriately prolonged in the clinical treatment of ICU patients with severe infection,which can not only eff ectively improve infl ammation,but also improve the clearance rate of pathogenic bacteria,and the curative eff ect is better than that of conventional time infusion,with higher safety.