开颅手术患者围手术期头皮携带细菌与感染的关系  

A prospective survey of the relationship between the bacteria existing in the scalp and the incidence of infections during perioperative period

作　　者：卓杰[1] 刘春生[1] 亢建民[1] 闫华[1] 

机构地区：[1]天津市环湖医院神经外科,天津300060

出　　处：《中华医院感染学杂志》2014年第16期4046-4048,共3页Chinese Journal of Nosocomiology

基　　金：天津市科技支撑计划基金资助项目(08ZCGYSF01600);天津市自然科学基金资助项目(13JCYBJC21100)

摘　　要：目的调查接受清洁切口开颅手术的患者在围手术期内头皮内携带细菌的构成及其与术后感染的关系,为术前合理选择预防性抗菌药物提供依据。方法以前瞻性分析方法选择2011年1月-2012年12月准备接受清洁切口开颅手术的患者672例,分别采集刚入院时、术前24h、术后24h和拆线时切口附近头皮标本进行细菌培养,将检出的菌株与同时期内科室空气中和医护人员体表采集到的细菌进行对比分析,采用SPSS17.0进行分析。结果 672例手术患者在入院时头皮中共检出细菌352株,其中革兰阳性菌276株占78.4%,术前24h共检出细菌438株,其中革兰阴性菌292株占66.7%,术后24h共检出细菌46株,伤口拆线时共检出细菌211株,术前、术后24h、拆线时检出的细菌,多数为致病力强、高耐药的医院细菌,与同时期内科室环境中的细菌有高度的同源性。结论住院病房环境中的细菌是围手术期内患者头皮致病菌的主要来源。OBJECTIVE To investigate the relationship between the bacteria existing in the scalp and the incidence of infections during perioperative period for patients undergoing craniotomy with clean incision,so as to provide reference for reasonable selection of preoperative prophylactic antibacterial agents.METHODS Base on a prospective strategy,a total of 672 patients who were expected to accept craniotomy with clean incision in our neurosurgery department from Jan.2011 to Dec.2012 were selected.Scalp samples nearby the expected incision were taken for bacterial culture at admission,24 h pre-operation,24 h post-operation and at the time of suture removing.The obtained bacterial strains were compared with those from the atmosphere and the body surface of the staff in our department during the same period.The analysis was conducted with SPSS 17.0.RESULTS The 672 surgical patients had 352 bacteria detected at admission,including 276 gram positive bacteria（78.4%）,and 438 at 24h pre-operation including 292 gram negative bacteria（66.7%）,46 at 24hpost-operation and 211 at the time of suture removing.Most of bacteria at 24 h pre-and post-operation and at the time of suture removing were highly pathogenic,highly drug-resistant and highly homologic with the bacteria from the atmosphere in our department at the same time.CONCLUSION Environment of the ward was the main source of the pathogens in the patient scalp during the perioperative period.

关 键 词：清洁切口开颅术 围手术期 头皮 细菌 

分 类 号：R181.32[医药卫生—流行病学]