老年心力衰竭合并肺部感染患者病原菌分布及其对血炎性因子水平影响研究

目的 分析老年心力衰竭（心衰）合并肺部感染的病原菌分布、心肺功能变化以及血炎性因子水平变化。方法 回顾性分析2014年3月—2017年9月在我院就诊的153例老年心衰患者的临床资料。依据患者是否并发肺部感染，将患者分为感染组（76例）及非感染组（77例），同时纳入同期体检健康者作为对照组（82例）。采集感染组患者呼吸道分泌物样本进行病原菌鉴定，比较3组患者心、肺功能和外周血炎性因子水平变化。结果 76例感染组患者共分离致病菌110株，其中革兰阴性菌81（73.63%）株，革兰阳性菌27（24.55%）株，真菌2（1.82%）株。与对照组和非感染组相比，感染组患者的第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1/FVC、一氧化碳弥散量（DLCO）及最大呼气中期流量（MMEF）等肺功能指标均明显下降；左心室舒张末期内径（LVEDD）和收缩末期内径（LVESD）增大，左室射血分数（LVEF）降低。同时感染组患者外周血肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6 及降钙素原（PCT）水平均高于未感染组及对照组，差异具有统计学意义（P＜0.05）。结论 合并肺部感染的老年心衰患者以革兰阴性菌感染为主，且感染后患者心肺功能显著降低，其血炎性因子水平显著升高，对判断感染程度具有辅助价值。

The pathogen distribution and its influence on inflammatory factors in old patients with heart failure complicated with pulmonary infection

Objective To explore the pathogen distribution, changes of cardiorespiratory function and changes of serum inflammatory factors in old patients with cardiac failure complicated with pulmonary infection. Methods A total of 153 cardiac failure patients hospitalized in our hospital from March 2014 to September 2017 were retrospectively analyzed.The patients were divided into pulmonary infected group (n=76) and non-infected group (n=77). Another 82 healthy subjects were served as control group. The respiratory secretions were collected to detect pathogen distribution in infected group. The changes of cardiac and pulmonary functions and peripheral blood inflammatory factors were compared between the three groups. Results A total of 110 pathogens were isolated from infected group, which contained 81 (73.63%) gram negative strains, 27 (24.55%) gram positive strains and 2 (1.82%) fungus. Compared with the control group and non-infected group, the lung function index and pulmonary function decreased significantly in the infected group, containing forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, carbon monoxide diffusing capacity (DLCO), maximum mid expiratory flow (MMEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD). Meanwhile, the serum levels of tumor necrosis factor (TNF) –α, interleukin (IL)-6 and procalcitonin (PCT) weresignificantly higher in the infected group than those in the non-infected group and the control group (P＜0.05).Conclusion Gram negative strains dominate in pulmonary infection of old patients with cardiac failure, and the cardiopulmonary function is significantly decreased due to the infection, whereas the serum levels of inflammatory factors are dramatically increased, which has an auxiliary value in the evaluation of pulmonary infection.