输卵管妊娠患者术后医院感染的病原学、危险因素及细胞因子水平分析

Analysis of the etiology,risk factors and cytokine levels of nosocomial infection in patients with tubal pregnancy

目的探讨输卵管妊娠患者术后发生医院感染的病原学特征,分析相关危险因素以及炎症因子水平变化情况。方法选取本院2018年1月-2021年1月收治的356例输卵管妊娠患者为研究对象,根据患者术后是否发生医院感染分为感染组(31例)和未感染组(325例)。采集感染组患者感染处分泌物进行病原菌的分离培养及鉴定,并对病原菌分布特点进行分析。收集所有患者临床资料,采用Logistic回归分析发生术后感染的危险因素,同时采用酶联免疫吸附法检测并比较两组患者血清中干扰素-α(interferon-α,IFN-α)、干扰素-γ(interferon-α,IFN-γ)以及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平。结果31例输卵管妊娠患者术后发生医院感染的主要感染部位为呼吸道、泌尿系统以及血液系统,分别占48.39%、22.58%和16.13%。共分离出48株病原菌,其中革兰阴性菌17株,革兰阳性菌26株,真菌5株,分别占35.42%、54.17%和10.42%。感染组患者血清IFN-α、IFN-γ和TNF-α水平均高于未感染组(均P<0.01)。Logistic回归分析显示,合并基础疾病(OR=2.328,95%CI 1.13~4.54)、术后留置导尿管(OR=2.807,95%CI 1.436~5.487)、手术时长(OR=3.080,95%CI 1.191~7.969)、住院时长(OR=2.565,95%CI 1.259~5.225)、血清白蛋白水平(OR=0.452,95%CI 0.222~0.918)均是输卵管妊娠患者术后感染发生的独立危险因素。结论输卵管妊娠患者发生术后医院感染的致病菌以革兰阳性菌为主,且感染会进一步加重患者炎性损伤。积极治疗基础疾病,尽量减少手术及住院时长,并根据药敏试验结果合理选择抗生素治疗,有利于降低感染发生的风险。

Objective To investigate the etiological characteristics of postoperative nosocomial infection in patients with tubal pregnancy,and to analyze the related risk factors and changes in the levels of inflammatory factors.Methods A total of 356 patients with tubal pregnancy who were treated in our hospital from January 2018 to January 2021 were selected as the research objects.According to whether there was nosocomial infection after operation they were divided into infection group(31 cases)and non-infection group(325 cases).The pathogenic bacteria collected from the secretions of infected patients in the infection group were isolated,cultured and identified,and the distribution characteristics of pathogenic bacteria was analyzed.The clinical data of all patients were collected,and logistic regression was used to analyze the risk factors for postoperative infection.At the same time,the serum levels of interferon-α(IFN-α),interferon-γ(IFN-γ)and tumor necrosis factor-α(TNF-α)in the two groups of patients was detected and compared by enzyme-linked immunosorbent assay.Results The main infection sites of postoperative nosocomial infection in 31 patients with tubal pregnancy were respiratory tract,urinary system and blood system,accounting for 48.39%,22.58%and 16.13%,respectively.A total of 48 pathogenic bacteria were isolated,including 17 gram-negative bacteria,26 gram-positive bacteria and 5 fungi,accounting for 35.42%,54.17%and 10.42%,respectively.The serum levels of IFN-α、IFN-γand TNF-αin infection groupwere higher than those in the uninfected group(P<0.01).The logistic regression analysis showed that the underlying diseases(OR=2.328,95%CI 1.13-4.54),postoperative indwelling catheter(OR=2.807,95%CI 1.436-5.487),operation time(OR=3.080,95%CI 1.191-7.969),hospitalization time(OR=2.565,95%CI 1.259-5.225)and serum albumin level(OR=0.452,95%CI 0.222-0.918)were independent risk factors for postoperative infection in patients with tubal pregnancy.Conclusion The pathogenic bacteria of postoperative nosocomial infection in patients with tubal pregnancy are mainly gram-positive bacteria,and infection will further aggravate the inflammatory injury of patients.Actively treating underlying diseases,minimizing the length of surgery and hospitalization,and rationally selecting antibiotic therapy based on the results of drug susceptibility tests can help reduce the risk of infection.