急诊重症肺炎并发感染性休克患者病原菌分布及护理效果分析

Study on the distribution characteristics of pathogens and clinical treatment nursing in patients with severe pneumonia complicated by septic shock in emergency department

目的探析急诊重症肺炎并发感染性休克患者的病原菌分布特点及临床治疗护理效果。方法选取急诊收治的42例重症肺炎并发感染性休克患者为本次研究对象。通过院内病例信息系统对患者进行中医证候要素诊断分类,辩证病例患者的中医证型。采集患者标本进行病原菌鉴定及药敏试验。检测血清氧化应激反应指标水平及临床肺部感染评分(CPIS),分析氧化应激反应指标水平与CPIS评分的相关性。将患者随机分为两组,一组采用综合护理方式,另一组采用一般护理方式,进行临床治疗护理效果对比。结果42例重症肺炎并发感染性休克患者中,以单一病原菌感染为主,共检出病原菌51株。革兰阴性菌39株,主要为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌。革兰阳性菌10株,主要为肺炎链球菌。真菌2株,白色假丝酵母菌与热带假丝酵母菌各1株。42例患者根据中医证候进行归类,可分为痰热壅肺证23例,气阴两虚证11例,痰湿阻滞证8例。三类患者中,革兰阴性菌、革兰阳性菌、真菌的构成比差异无统计学意义(P>0.05)。革兰阴性菌对氨苄西林、环丙沙星、左氧氟沙星、庆大霉素的耐药率高于50%,分别为100%、71.79%、69.23%和58.97%,对美罗培南、亚胺培南、阿米卡星的耐药率低于30%,分别为23.08%、17.95%、5.13%。革兰阳性菌对青霉素、红霉素、环丙沙星、左氧氟沙星、庆大霉素、复方新诺明的耐药率高于50%,分别为100.00%、80.00%、60.00%、70.00%、60.00%和60.00%,未产生对万古霉素、利奈唑胺的耐药株。42例患者血清SOD水平为(5.14±0.86)U/mL,MDA为(8.46±1.21)mmol/L,LPO为(21.52±2.63)μmol/L,CPIS评分为(9.21±1.49)分,血清MDA、LPO水平与CPIS评分呈正相关,血清SOD水平与CPIS评分呈负相关(P<0.05)。综合护理组患者总有效率为85.71%,细菌清除率为80.95%,机械通气时间为(9.48±1.83)d,住院时间为(24.90±3.16)d,一般护理组患者总有效率为52.38%(11/21),细菌清除率为47.62%(10/21),机械通气时间为(11.67±1.56)d,住院时间为(30.95±2.71)d,两组患者治疗效果差异有统计学意义(P<0.05)。综合护理组与一般护理组患者治疗前PaO_(2)、PaCO_(2)、氧合指数差异无统计学意义(P>0.05),治疗一周后,综合护理组患者PaO_(2)、氧合指数水平高于一般护理组患者,PaCO_(2)水平低于护理组患者,差异有统计学意义(P<0.05)。结论急诊重症肺炎并发感染性休克患者主要为痰热壅肺证,病原菌主要为革兰阴性菌,以肺炎克雷伯菌为主,对抗菌药物的耐药率较高。血清MDA、LPO水平与CPIS评分呈正相关,血清SOD水平与CPIS评分呈负相关。对患者进行综合护理措施,可以有效提高临床治疗效果。

Objective To explore the distribution characteristics of pathogens and clinical treatment and nursing effects in patients with severe pneumonia complicated by septic shock in emergency department.Methods 42 patients with severe pneumonia complicated by septic shock admitted to the emergency department of our hospital were selected as the subjects of this study.The TCM syndrome elements of patients was diagnosed and classified by the hospitals case information system,and the TCM syndrome types of patients differentiated.The patient specimens were collected for pathogen identification and drug sensitivity testing.The levels of serum oxidative stress response indicators and clinical pulmonary infection score(CPIS)were detected,to analyze the correlation between the levels of oxidative stress response indicators and CPIS score.The patients were randomly divided into two groups,one group receiving comprehensive nursing care and the other group receiving general nursing care,to compare the clinical treatment and nursing effects.Results Among 42 patients with severe pneumonia complicated by septic shock,single pathogen infection was the main cause,and a total of 51 strains of pathogens were detected.39 strains were Gram negative bacteria,mainly Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia coli.10 strains were Gram positive bacteria,mainly Streptococcus pneumoniae.Two strains were fungi,one white yeast and one tropical yeast.42 patients were classified according to traditional Chinese medicine syndrome,which can be divided into 23 cases of phlegm heat obstructing the lung syndrome,11 cases of qi yin deficiency syndrome,and 8 cases of phlegm dampness obstruction syndrome.There was no statistically significant difference in the composition ratio of Gram negative bacteria,Gram positive bacteria,and fungi among the three types of patients(P>0.05).The resistance rates of Gram negative bacteria to ampicillin,ciprofloxacin,levofloxacin,and gentamicin were over 50%,100%,71.79%,69.23%,and 58.97%,respectively.The resistance rates to meropenem,imipenem,and amikacin were less than 30%,23.08%,17.95%,and 5.13%,respectively.Gram positive bacteria had a resistance rate of over 50%to penicillin,erythromycin,ciprofloxacin,levofloxacin,gentamicin,and compound sulfamethoxazole,which were 100%,80%,60%,70%,60%,and 60%,respectively.No resistant strains to vancomycin or linezolid had been developed.The level of SOD was(5.14±0.86)U/mL,the level of MDA was(8.46±1.21)mmol/L,the level of LPO was(21.52±2.63)μmol/L,and the CPIS score was(9.21±1.49)points in 42 patients serum,serum MDA and LPO levels were positively correlated with CPIS score,while serum SOD level was negatively correlated with CPIS score(P<0.05).The total effective rate of patients in the comprehensive nursing group was 85.71%,the bacterial clearance rate was 80.95%,the mechanical ventilation time was(9.48±1.83)days,and the hospital stay was(24.90±3.16)days.The total effective rate of patients in the general nursing group was 52.38%(11/21),the bacterial clearance rate was 47.62%(10/21),the mechanical ventilation time was(11.67±1.56)days,and the hospital stay was(30.95±2.71)days.The difference in treatment effects between the two groups was statistically significant(P<0.05).The difference in PaO_(2),PaCO_(2),and oxygenation index between the comprehensive nursing group and the general nursing group before treatment was not statistically significant(P>0.05).After one week of treatment,the levels of PaO_(2) and oxygenation index in the comprehensive nursing group were higher than those in the general nursing group,while the levels of PaCO_(2) were lower than those in the nursing group.The difference was statistically significant(P<0.05).Conclusion Emergency patients with severe pneumonia complicated by septic shock were mainly characterized by phlegm heat obstruction in the lungs,and the pathogenic bacteria were mainly Gram negative bacteria,mainly K.pneumoniae,with a high resistance rate to antibiotics.The levels of serum MDA and LPO were positively correlated with CPIS score,while the levels of serum SOD were negatively correlated with CPIS score.Comprehensive nursing measures for patients can effectively improve clinical treatment effectiveness.