呼吸机相关肺部感染对老年冠心病急性左心衰竭患者预后的影响

发布时间：2018-06-28 12:54

本文选题：冠心病 + 急性左心衰竭　；参考：《中国老年学杂志》2017年01期

【摘要】：目的分析老年冠心病(CAD)致急性左心衰竭(ALVF)患者呼吸机相关肺部感染(VAP)病原菌分布及对预后的影响。方法接受机械通气治疗的CAD所致ALVF患者依据是否并发VAP分为:感染组(并发VAP,65例)及未感染组(未并发VAP,106例)。采用法国生物梅里埃微生物全自动鉴定仪进行病原菌鉴定分型,并分析感染后心肺功能、炎症水平及住院期间死亡率。另纳入80例同期体检健康人员作为对照组。结果感染组分离致病菌65株,其中革兰阴性菌35株(53.85%);革兰阳性菌27株(41.54%);真菌3株(4.62%)。感染组住院期间死亡率显著高于未感染组(P0.05)。感染组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1%及FEV1/FVC均显著低于未感染组及对照组(P0.05)。感染组外周血肌钙蛋白(Tn I)、心肌型肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)、C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及干扰素(IFN)-γ水平显著高于未感染组及对照组(P0.05)。结论 CAD所致ALVE患者如并发VAP可导致死亡率显著升高,这可能与感染导致的呼吸功能降低、心功能恶化及全身性炎症反应加剧有关。
[Abstract]:Objective to analyze the pathogenic bacteria distribution and prognosis of ventilator associated pulmonary infection (VAP) in elderly patients with acute left heart failure (ALVF) caused by coronary heart disease (CAD). Methods patients with CAD induced by mechanical ventilation were divided into infection group (65 cases) and non-infected group (106 cases) according to whether they were complicated with VAP. The pathogen identification and typing were carried out by using the French Biomellier microorganism automatic identification instrument. The cardiopulmonary function, inflammation level and mortality rate during hospitalization were analyzed after infection. Another 80 healthy persons were included as control group. Results 65 strains of pathogenic bacteria were isolated in the infection group, of which 35 were Gram-negative bacteria (53.85%), 27 were Gram-positive bacteria (41.54%), and 3 were fungi (4.62%). The in-hospital mortality of infection group was significantly higher than that of non-infection group (P0.05). Forced vital capacity (FVC), forced expiratory volume (FEV1) and FEV1 / FVC in infected group were significantly lower than those in uninfected group and control group (P0.05). The levels of troponin I (TNI), myocardial creatine kinase isoenzyme (CK-MB), brain natriuretic peptide (BNP) C-reactive protein (CRP), tumor necrosis factor (TNF)-伪, interleukin (IL) -6 and interferon (IFN)-纬 in infected group were significantly higher than those in uninfected group and control group (P0.05). Conclusion the death rate of patients with CAD induced ALVE complicated with VAP is significantly increased, which may be related to the decrease of respiratory function, deterioration of cardiac function and aggravation of systemic inflammation induced by infection.
【作者单位】：山西省心血管病医院心血管外科;山西医科大学第二医院心内科;
【基金】：山西省科技厅自然科学基金项目(No.2013011050-3)
【分类号】：R541;R563.1

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