慢性心力衰竭患者肺部感染的临床特征及免疫功能分析

发布时间：2018-07-25 13:44

【摘要】：目的分析慢性心力衰竭患者发生肺部感染的临床状况及免疫功能,探讨分离出的各种菌株耐药性。方法选择2015年6月-2016年6月医院接诊280例慢性心力衰竭患者,根据住院期间患者发生肺部感染与否,分为观察组124例和对照组156例,分析两组患者的一般临床资料,观察合并肺部感染患者的临床表现及感染相关因素,比较两组患者T淋巴细胞亚群和血清免疫球蛋白水平,分析病原菌的耐药性及两组患者的预后情况等,分析肺部感染危险因素。结果两组患者住院时间和糖尿病史差异有统计学意义(P0.05);慢性心力衰竭患者肺部感染后出现咳嗽、发热、胸痛等呼吸系统典型症状患者58例占46.77%;痰培养结果显示,124例患者培养致病菌108株,革兰阴性菌占48.15%,革兰阳性菌占30.56%,真菌23株占21.29%;两组患者免疫功能分析比较显示,两组患者CD_8~+、CD_4~+/CD_8~+、IgG和IgM水平差异有统计学意义(P0.05);两组患者在CD_4~+和IgA水平方面差异无统计学意义;两组患者在肺部感染因素中,平均NYHA分级、有创检查/治疗、制酸剂和预防应用抗菌药物方面差异有统计学意义(P0.05)。结论慢性心力衰竭患者极易出现肺部感染,临床症状较多,病原菌构成复杂,应根据药敏试验结果选用合适的抗菌药物,以达到控制和预防医院感染的目的。
[Abstract]:Objective to analyze the clinical status and immune function of pulmonary infection in patients with chronic heart failure. Methods 280 patients with chronic heart failure were selected from June 2015 to June 2016. According to the pulmonary infection or not, the patients were divided into observation group (124 cases) and control group (156 cases). The general clinical data of the two groups were analyzed. The clinical manifestations and infection related factors of patients with pulmonary infection were observed. The T lymphocyte subsets and serum immunoglobulin levels were compared between the two groups. The drug resistance of pathogenic bacteria and the prognosis of the two groups were analyzed. The risk factors of pulmonary infection were analyzed. Results there were significant differences in hospitalization time and diabetes history between the two groups (P0.05), cough and fever appeared in patients with chronic heart failure after pulmonary infection. The results of sputum culture showed that 108 strains of pathogenic bacteria, 48.15% of gram-negative bacteria, 30.56% of gram-positive bacteria and 21.29 strains of fungi were cultured in 124 patients. There were significant differences in the levels of CD8 ~ / CD8 ~ + IgG and IgM between the two groups (P0.05); there was no significant difference in CD4 ~ and IgA levels between the two groups; among the pulmonary infection factors, there was an average NYHA grade with invasive examination / treatment in the two groups. There was a significant difference in acid preparation and prophylactic use of antimicrobial agents (P0.05). Conclusion patients with chronic heart failure are prone to pulmonary infection, with more clinical symptoms and complex pathogenic bacteria. Appropriate antimicrobial agents should be selected according to the results of drug sensitivity test in order to control and prevent nosocomial infection.
【作者单位】：武警浙江省总队嘉兴医院心内科;
【基金】：浙江省中西医结合学会科研基金资助项目(2013LYSX094)
【分类号】：R563.1;R541.6

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