摘要
目的探讨自然分娩产后产褥感染病原菌分布及血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平。方法选择台州医院2017年1—12月自然分娩产妇6 632例,对怀疑产褥感染产妇的痰液、会阴切口分泌物、宫颈分泌物等标本进行病原学培养及药敏试验,采用免疫比浊法测定血清CRP水平,采用酶联免疫吸附实验(ELISA)法测定血清TNF-α、IL-6、IL-10水平。结果 6 632例自然分娩产妇产后产褥感染246例,感染率为3. 71%。自然分娩产后产褥感染按部位为会阴切口感染、呼吸道感染、乳腺感染,构成比分别为73. 98%、17. 07%、8. 94%。246例产褥感染患者中培养出病原菌297株,主要病原菌为大肠埃希菌、无乳链球菌、粪肠球菌,分别占45. 12%、23. 91%和15. 82%。大肠埃希菌对青霉素、林可霉素、阿奇霉素、头孢唑啉、复方新诺明的耐药率比较高,耐药率分别为100. 00%、95. 52%、85. 07%、83. 58%、80. 60%;无乳链球菌对青霉素、哌拉西林、环丙沙星、林可霉素耐药率比较高,耐药率分别为100. 00%、100. 00%、98. 59%、97. 18%;粪肠球菌对青霉素、林可霉素耐药率比较高,耐药率分别为100. 00%、89. 36%。产褥感染组血清CRP、TNF-α、IL-6、IL-10水平均高于无产褥感染组(P <0. 05)。结论自然分娩产后产褥感染病原菌以大肠埃希菌、无乳链球菌、粪肠球菌为主,主要病原菌耐药性较高,产褥感染产妇血清TNF-α、IL-6、IL-10水平升高。
Objective To investigate the distribution of pathogenic bacteria in postpartum puerperal infections and the serum C-reactive protein （CRP）, tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6）, interleukin-10 （IL-10） and procalcitonin （PCT） levels. Methods Total 6 632 cases of mothers of natural delivery were selected in hospitals from January, 2017 to December, 2017. Etiological culture and drug susceptibility tests were performed on specimens of puerperal fluid, perineal incision secretions, cervical secretions, etc. of suspected maternity-infected mothers. The level of serum CRP was measured by immunoturbidimetry. The serum TNF-α, IL-6 and IL-10 levels were determined by enzymelinked immunosorbent assay （ELISA）. Results There were 246 cases of maternal puerperal infection in 6 632 cases, the infection rate was 3.71%. Postpartum puerperal infection sites were perineal wound infections, respiratory infections, and breast infections. The constituent ratios were 73.98% , 17.07% and 8.94% , respectively. Among 246 cases of puerperal infection, 297 strains of pathogenic bacteria were cultivated. The main pathogens were Escherichia coli, Streptococcus agalactiae, and Enterococcus faecalis, accounting for 45.12% , 23.91% and 15.82% , respectively. The resistance rates of Escherichia coli to penicillin, lincomycin, azithromycin, cefazolin, and compound sulfamethoxazole were relatively high, and the drug resistance rates were 100.00% , 95.52% , 85.07% , 83.58% and 80.60% , respectively. The resistance rates of Streptococcus agalactiae to penicillin, piperacillin, ciprofloxacin and lincomycin were relatively high, and the drug resistance rates were 100.00% , 100.00% , 98.59% and 97.18% , respectively. Enterococcus faecalis had high resistance rates to penicillin and lincomycin, and the resistant rates were 100.00% and 89.36% , respectively. The serum levels of CRP, TNF-α, IL-6 and IL-10 in the puerperal infection group were higher than those in the puerperal uninfected group （ P 〈 0.05 ）. Conclusion The most common pathogens for postpartum puerperal infections of natural labor are Escherichia coli, Streptococcus agalactiae, and Enterococcus faecalis. The main pathogens are highly resistant, and maternal serum levels of TNF-α, IL-6 and IL-10 are increased.
作者
祝莹
张紫娟
王丹阳
朱虹
应柳青
祁锋
ZHU Ying;ZHANG Zi-juan;WANG Dan-yang(Department of Obstetrics and Gynecology,Taizhou Enze Medical Center（Group）Zhejiang Taizhou Hospital,Taizhou,Zhejiang 317000,China)
出处
《中华全科医学》
2018年第11期1854-1856,1863,共4页
Chinese Journal of General Practice
基金
浙江省医药卫生科技计划项目(2018KY893)
