择期开腹结直肠癌患者术后切口感染的病原学特点及炎性因子表达分析  

Etiological characteristics of postoperative incisional infection in patients with elective open colorectal cancer and expression analysis of inflammatory factors

作　　者：罗灿军[1,2] 黄威[2] 王理[2] 吴文涌[1] 

机构地区：[1]安徽医科大学第一附属医院胃肠外科,安徽合肥230022 [2]解放军第113医院普外科,浙江宁波315040

出　　处：《中华医院感染学杂志》2017年第11期2536-2538,2542,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81572305)

摘　　要：目的研究择期开腹结直肠癌患者术后切口感染的病原学特点,并分析其相关炎性因子表达情况。方法选择2011年3月-2015年5月医院接受治疗的结直肠癌患者160例,采用全自动细菌培养仪以及纸片扩散法(K-B法)对患者切口感染的病原菌及药敏性进行培养和监测;在感染治疗前后采集患者静脉血,对其白介素以及其它炎性因子表达水平进行分析。结果 160例开腹结直肠癌患者术后切口感染28例,感染率为17.5%;28例感染患者共分离出病原菌42株,其中以革兰阴性菌为主占64.3%;革兰阴性菌中大肠埃希菌和铜绿假单胞菌对头孢曲松和头孢唑肟的耐药率高达80.0%以上,对头孢吡肟的耐药率也达50.0%以上;患者感染治疗前白介素及其他炎性因子的水平均较高,治疗3d、7d后患者白介素水平和其他炎性因子水平下降最快,尤以第7天明显,差异有统计学意义(P<0.05)。结论对患者进行抗炎治疗时要依据药敏试验结果联合用药,同时密切观察患者机体炎性水平变化,有利于改善患者预后、减轻患者经济负担,值得临床推广。OBJECTIVE To investigate the etiological characteristics of postoperative incisional infection in patients with elective open colorectal cancer and to analyze the expression of related inflammatory factors.METHODS A total of 160 patients with colorectal cancer treated in our hospital from Mar.2011 to May 2015 were enrolled in this study.The pathogens and drug susceptibility of incisional infection were cultured and monitored with automatic bacterial culture instrument and paper diffusion method （K B method）.The venous blood were collected before and after the treatment of infection,and the expressions of interleukins and other inflammatory factors were analyzed.RESULTS Among 160 cases of open colorectal cancer patients,the postoperative incision infection occurred in 28 cases,and the infection rate was 17.5%.A total of 42 strains of pathogens were isolated from 28 infected patients,of which 64.3 % were predominantly gram-negative bacteria.The resistant rates of Escherichia coli and Pseudomonas aeruginosa to ceftriaxone and ceftizoxime were higher than 80%,and the resistant rate to cefepime were more than 50%.The levels of interleukins and other inflammatory factors before the treatment of infection were high,and the levels of interleukins and other inflammatory factors decreased the fastest at 3 d and 7 d of the treatment,especially on the 7th day （P〈 0.05）.CONCLUSION The anti-inflammatory treatment of patients should be based on the drug susceptibility test results,at the same time,the changes of inflammatory level should be observed,which is help to improve the prognosis of patients and reduce the economic burden.It is worthy of clinical promotion.

关 键 词：择期 结直肠癌 切口感染 病原菌 炎性因子 

分 类 号：R657.1[医药卫生—外科学]