心脏外科术后深部胸骨切口感染临床特点及病原学分析  

Clinical characteristics of deep sternal wound infections after cardiac surgery and etiological analysis

作　　者：张继凤[1] 杨侃[1] 夏海娜[1] 杜守峰[1] 齐博[1] 曹博[1] ZHANG Ji-feng YANG Kan XIA Hai-na DU Shou-feng QI Bo CAO Bo(Nanyang Central Hospital, Nanyang, Henan 473000, Chin)

机构地区：[1]南阳市中心医院心脏大血管外科,河南南阳473000

出　　处：《中华医院感染学杂志》2017年第5期1145-1148,共4页Chinese Journal of Nosocomiology

基　　金：河南省基础与前沿技术研究项目(102401523329)

摘　　要：目的分析心脏外科术后深部胸骨切口感染临床特点及病原学,为临床预防与治疗提供依据。方法回顾性分析2005年1月-2015年12月在医院行心脏手术患者3479例,其中术后发生深部胸骨切口感染的患者73例;分析不同临床分型的心脏外科术后深部胸骨切口感染临床特点,病原学及药敏分析结果。结果年龄30~55岁患者发生术后深部胸骨切口感染率更高,与<30岁比较,差异有统计学意义(P<0.01);Ⅰ型15例,占20.5%,Ⅱ型43例,占58.9%,Ⅲ型15例,占20.5%。Ⅲ型患者T≥38℃、伤口裂开或者脓性分泌物、自发性疼痛、WBC>10×109/L、低蛋白血症比例显著低于Ⅰ型患者,差异有统计学意义(P<0.05),Ⅱ型X线或者CT显示纵膈增宽比例最高,差异有统计学意义(P<0.05);73例患者32例病原菌诊断明确,分离出病原菌81株,其中革兰阴性菌44株,占54.3%,革兰阳性菌32株,占39.5%,真菌5株,占6.2%;革兰阴性菌耐药结果分析显示三种细菌对头孢唑林、头孢呋辛的耐药率均达到了100%;革兰阳性菌对青霉素G的耐药率达到了100%,而替加环素、利奈唑胺、万古霉素的敏感性较高。结论高龄患者心脏外科术后容易并发深部胸骨切口感染,其中以Ⅱ型多见。临床预防及治疗应结合临床特征以及病原学结果。OBJECTIVE To observe the clinical characteristics of deep sternal wound infections after cardiac surgery and analyze the etiology so as to provide guidance for clinical prevention and treatment. METHODS A total of 3479 patients who underwent cardiac surgery in the hospital from Jan 2005 to Dec 2015 were retrospectively analyzed, including 73 patients with postoperative deep sternal wound infection. The clinical characteristics of the postoperative deep sternal wound infections in the patients undergoing different classifications of cardiac surgery, result of etiological analysis, and result of drug susceptibility testing were observed. RESULTS The incidence rate of the postoperative deep sternal wound infection was even higher in the patients aged between 30 and 55 years old, as compared with the patients aged less than 30 years old （P〈0.01）. There were 15 （20.5%） cases of type Ⅰ , 43 （58.9%） cases of type Ⅱ , and 15 （20.5%） cases of type Ⅲ. The proportion of the type Ⅲ patients with T no less than 38℃, wound dehiscence or purulent secretion, spontaneous pain, white blood cell counts more than 10× 109/L, or hypoproteinemia was significantly lower than that of the type Ⅱ patients （P〈0.05）. The X-ray or CT showed that the mediastinal widening rate of the type Ⅱ patients was highest, and there was the significant differ- ence （P〈0.05）. The pathogens were definitely identified for 32 of 73 patients, totally 81 strains of pathogens were isolated, including 44 （54.3%） strains of gram-negative bacteria, 32 （39.5%） strains of gram-positive bacz teria, and 5 （6.2%） strains of fungi. The result of the drug susceptibility testing for the gram-negative bacteria indicated that the drug resistance rate of three species to cefazolin and cefuroxime was as high as 100% the drug resistance rate of the gram-positive bacteria to penicillin G was 100%, however, the strains were highly susceptible to tigecycline, linezolid, and vancomycin. CONCLUSION The aged patients are prone

关 键 词：心脏外科术 深部胸骨切口感染 临床特点 

分 类 号：R378[医药卫生—病原生物学]