断指再植术后感染的病原学特点及相关血清标记物的水平变化分析

发布时间：2018-06-29 15:15

本文选题：断指再植 + 术后感染　；参考：《中华医院感染学杂志》2017年17期

【摘要】：目的了解断指患者行断指再植术后感染病原学特点以及血清肿瘤坏死因子(TNF-α)、基质细胞衍生因子(SDF-1)、血管内皮生长因子(VEGF)和内皮素水平的变化情况。方法选择2013年4月-2016年3月在医院行断指再植术的患者1 200例,依据患者术后是否发生感染分为感染组和非感染组,采用全自动微生物分析仪和K-B法对送检标本进行细菌培养和药敏试验,同时利用酶联免疫吸附法测定断指再植术后患者血清中TNF-α、SDF-1、VEGF及内皮素水平。结果 1 200例断指再植患者术后发生感染129例,感染率为10.8%,从各年度的感染率情况来看,呈逐年下降趋势(χ~2=8.32,P0.05);129例断指再植术后感染患者检出病原菌163株,其中革兰阳性菌105株占64.4%,以表皮葡萄球菌和金黄色葡萄球菌为主;革兰阴性菌58株占35.6%,以铜绿假单胞菌和鲍氏不动杆菌为主;表皮葡萄球菌、金黄色葡萄球菌及溶血葡萄球菌对青霉素G的耐药率达100.0%,对呋喃妥因、万古霉素及利奈唑胺耐药率为0;主要革兰阴性菌对氨苄西林的耐药率在72.7%~100.0%,但对亚胺培南、呋喃妥因及美罗培南的耐药率为0;断指再植术后感染患者血清中TNF-α、SDF-1、VEGF及内皮素水平要明显高于未感染组,差异有统计学意义(t=9.234~31.251,P0.05)。结论断指再植术后清创不彻底极易受到病原菌感染,且术后感染导致其血清中SDF-1、TNF-α、VEGF及内皮素水平升高,血清标记物水平变化可用于断指再植术后感染的诊治。
[Abstract]:Objective to investigate the etiological characteristics of severed finger replantation and the changes of serum tumor necrosis factor (TNF- 伪), stromal cell derived factor (SDF-1), vascular endothelial growth factor (VEGF) and endothelin (et). Methods 1,200 patients with replantation of severed fingers in hospital from April 2013 to March 2016 were selected and divided into infected group and non-infected group according to whether infection occurred after operation. The bacterial culture and drug sensitivity test were carried out by automatic microbiological analyzer and K-B method. The levels of VEGF and endothelin in serum of patients with severed finger replantation were measured by enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay). Results there were 129 cases of infection after replantation of severed finger, the infection rate was 10.8%. According to the infection rate of each year, the infection rate was decreasing year by year (蠂 2 + 8.32% P 0.05). 163 strains of pathogenic bacteria were detected in 129 cases of infection after replantation of severed finger. Among them, 105 Gram-positive bacteria accounted for 64.4%, mainly Staphylococcus epidermidis and Staphylococcus aureus; 58 Gram-negative bacteria accounted for 35.6B, mainly Pseudomonas aeruginosa and Acinetobacter baumannii; Staphylococcus epidermidis, Staphylococcus epidermidis, The resistance rate of Staphylococcus aureus and Staphylococcus haemolyticus to penicillin G was 100.0.The resistance rate to furantoin, vancomycin and linazolamide was 0; the resistance rate of the main gram-negative bacteria to ampicillin was 72.7100.0. but to imipenem. The drug resistance rate of furantoin and meropenem was 0. The serum levels of VEGF and endothelin in infected patients with severed finger replantation were significantly higher than those in non-infected group (t 9.234 卤31.251 P 0.05). Conclusion debridement after replantation of severed fingers is easy to be infected by pathogenic bacteria, and postoperative infection can lead to the increase of serum levels of VEGF and endothelin in patients with severed finger replantation. The changes of serum markers can be used in the diagnosis and treatment of infection after replantation of severed fingers.
【作者单位】：沧州市中心医院骨一科;沧州中西医结合医院手外科;
【基金】：河北省科技厅科技攻关基金资助项目(12276104D-14)
【分类号】：R658.1

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