院内G^-菌感染后全身炎症反应综合征的研究

Prospective study of systemic inflammatory response syndrome of patients with nosocomial G- bacteria infection

目的 :研究院内下呼吸道革兰阴性 (G- )菌感染后全身炎症反应综合征 (SIRS)的特点 ,探讨有效治疗方法。方法 :从 1998年开始 ,采用前瞻性随机对照研究方法 ,共选 82例院内下呼吸道感染后 SIRS患者 ,按发病时间先后随机分为两组 ,观察组 4 2例 ,对照组 4 0例 ,进行痰细菌培养 +药物敏感试验。对照组采用常规治疗 ,观察组则给予大黄制剂口服并使用引发内毒素少的敏感抗生素治疗。比较两组中 G-菌感染后 SIRS患者在不同治疗后 SIRS的病程、多器官功能障碍综合征 (MODS)的发生率及患者的病死率 ,并进行统计学处理。结果 :观察组与对照组 SIRS的病程分别为 (6 .2± 1.3) d和 (7.4± 1.2 ) d,u=3.91,P<0 .0 5 ;观察组与对照组 MODS的发生率分别为 11.4 %和 32 .3% ,χ2 =4 .2 7,P<0 .0 5 ;观察组与对照组的病死率分别为 8.6 %和 2 9.0 % ,χ2 =5 .0 5 ,P<0 .0 5。结论 :大黄制剂联合释放内毒素少的敏感抗生素对院内下呼吸道 G- 菌感染后 SIRS的治疗较常规治疗病程缩短 ,可使 MODS的发生率及患者病死率均降低。

Objective: To study the characteristics of systemic inflammatory response syndrome(SIRS) of inpatients with nosocomial G- bacteria infection in order to find on effective treatment. Methods: Eighty-two inpatients of SIRS with lower respiratory tract infection with G- bacteria were studied prospectively until discharge or death. They were divided into two groups: observation group(42 cases) and control group ( 40 cases). Bacteria culture of sputum and drug sensitivity were performed. Routine treatment was carried out in the control group, and rhubarb and antibiotics with lower endotoxin releasing property were given to the observation group. The course of SIRS, the incidence of MODS, and the mortality were compared. Results: The duration with SIRS in observation group and control group was respectively (6.2±1.3) days and (7.4±1.2)days, u=3.91,P<0.05; the incidence of MODS was 11.4 percent and 32.3 percent, respectively, χ2=4.27, P<0.05. The mortality rates of the patients with SIRS in two groups were 8.6 percent and 29.0 percent, respectively. Conclusion: The results indicated that the treatment with rhubarb could obviously reduce the duration of SIRS compared with routine method. The same is true in the incidence of MODS and mortality rate.