急诊重症肺炎并发感染性休克的临床特点及相关影响因素分析

Clinical characteristics and related influencing factors of severe pneumonia complicated with septic shock in emergency department

目的探析急症重症肺炎并发感染性休克的临床特点及相关影响因素。方法选取55例于本院进行治疗的急诊重症肺炎并发感染性休克患者及同期60例急症重症肺炎未并发感染性休克患者为本次研究对象。通过院内电子病例系统,收集符合研究标准患者的相关临床资料,分析急诊重症肺炎并发感染性休克的临床特点及相关影响因素。采集患者痰液、血液、尿液等相关标本,经培养分离后,采用全自动微生物鉴定系统进行菌种鉴定。鲍曼不动杆菌经增菌培养后,采用全自动细菌鉴定/药敏检测系统进行药敏试验。采用聚合酶链式反应检测鲍曼不动杆菌毒力基因携带情况。结果55例急诊重症肺炎并发感染性休克患者中,主要于冬季发病(38.18%,21/55),夏季发病人数最少(16.36%,9/55)。临床症状以肺部湿啰音为主(54.55%,30/55),其次为发热、呕吐、腹痛、咳嗽、咳痰等。共检出病原菌62株。革兰阴性菌共45株,主要为鲍曼不动杆菌(35.48%,22/62)。革兰阳性菌共12株,主要为肺炎链球菌(9.68%,6/62)。真菌共5株,主要为白色假丝酵母菌(4.84%,3/62)。22株鲍曼不动杆菌对亚胺培南、美罗培南、左氧氟沙星、环丙沙星、庆大霉素的耐药率较高,分别为59.09%、68.18%、59.09%、54.55%、68.18%,对米诺环素、替加环素的耐药率较低,分别为9.09%、4.55%。22株鲍曼不动杆菌中,adeH基因携带率100%(22/22),ompA基因携带率95.45%(21/22),csuA基因携带率90.91%(20/22),abaI基因携带率81.82%(18/22),babR基因携带率63.64%(14/22),bap基因携带率59.09%(13/22),hemO基因携带率54.55%(12/22)。研究组与对照组患者在糖尿病、肺叶受累数量、器官受累数量、合并慢阻肺、合并消化道出血、侵入性操作、住院时间方面对比差异具有统计学意义(P<0.05),在高血压、机械通气治疗方面对比差异无统计学意义(P>0.05)。肺叶受累数量≥3个、器官受累数量≥3个、合并慢阻肺、合并消化道出血、侵入性操作是急诊重症肺炎并发感染性休克的独立危险因素(P<0.05)。结论急诊重症肺炎并发感染性休克患者主要于冬季发病,临床症状以肺部湿啰音为主,病原菌以革兰阴性菌为主,主要为鲍曼不动杆菌。鲍曼不动杆菌对临床常见抗菌药物的耐药率较高,携带多种毒力基因。肺叶受累数量≥3个、器官受累数量≥3个、合并慢阻肺、合并消化道出血、侵入性操作是急诊重症肺炎并发感染性休克的独立危险因素。

Objective To explore the clinical characteristics and related influencing factors of acute severe pneumonia complicated with septic shock.Methods 55 emergency severe pneumonia patients complicated with septic shock who received treatment in our hospital and 60 emergency severe pneumonia patients without septic shock during the same period were selected as the study subjects.The relevant clinical data of patients who meet the research standards were collected through the hospital's electronic case system,the clinical characteristics and related influencing factors of infectious shock in emergency severe pneumonia were analyzed.The relevant specimens such as sputum,blood,and urine from patients were collected,cultured and isolated,then identified by a fully automated microbial identification system.After enrichment culture,A.baumannii was subjected to drug sensitivity testing by a fully automated bacterial identification/drug sensitivity detection system.The carrying of virulence genes in A.baumannii were detected by polymerase chain reaction.Results Among 55 emergency patients with severe pneumonia complicated by septic shock,the incidence was mainly in winter(38.18%,21/55),and the incidence was the lowest in summer(16.36%,9/55).The clinical symptoms were mainly moist rales in the lungs(54.55%,30/55),followed by fever,vomiting,abdominal pain,cough,sputum production,etc.A total of 62 strains of pathogenic bacteria were detected.There were 45 strains of Gram negative bacteria,mainly A.baumannii(35.48%,22/62).There were a total of 12 Gram positive bacteria,mainly Streptococcus pneumoniae(9.68%,6/62).There were a total of 5 fungi,mainly Candida albicans(4.84%,3/62).The resistance rates of 22 strains of A.baumannii to imipenem,meropenem,levofloxacin,ciprofloxacin,and gentamicin were high,59.09%,68.18%,59.09%,54.55%,and 68.18%,respectively.The resistance rates to minocycline and tigecycline were low,9.09%and 4.55%,respectively.Among the 22 strains of A.baumannii,the carrying rates of adeH gene were 100%(22/22),ompA gene was 95.45%(21/22),csuA gene was 90.91%(20/22),abaI gene was 81.82%(18/22),babR gene was 63.64%(14/22),bap gene was 59.09%(13/22),and hemO gene was 54.55%(12/22).There were statistically significant differences between the study group and the control group in terms of diabetes,the number of lung lobes involved,the number of organs involved,the combination of chronic obstructive pulmonary disease,the combination of gastrointestinal bleeding,invasive operations,and hospital stay(P<0.05),while there were no statistically significant differences in terms of hypertension and mechanical ventilation treatment(P>0.05).The number of affected lung lobes≥3,organ involvement≥3,concomitant chronic obstructive pulmonary disease,concomitant gastrointestinal bleeding,and invasive procedures were independent risk factors for septic shock in emergency severe pneumonia(P<0.05).Conclusion Patients with severe pneumonia complicated by septic shock in the emergency department mainly occurred in winter,with clinical symptoms mainly characterized by moist rales in the lungs.The pathogen was mainly Gram negative bacteria,mainly A.baumannii.A.baumannii had a high resistance rate to common clinical antibiotics and carried multiple virulence genes.The number of affected lung lobes≥3,number of affected organs≥3,concomitant chronic obstructive pulmonary disease,concomitant gastrointestinal bleeding,and invasive procedures were independent risk factors for septic shock in emergency severe pneumonia.