心脏搭桥手术患者术后感染因素分析与预防  

Influencing factors for postoperative infections in patients undergoing heart bypass surgery and prevention measures

作　　者：齐鑫[1,2] 赵岳[1] 李杰[2] 周文娟[2] 王勇[3] 

机构地区：[1]天津医科大学护理学院,天津300070 [2]天津市胸科医院心外科,天津300051 [3]天津药物研究院药业有限责任公司,天津300301

出　　处：《中华医院感染学杂志》2017年第16期3695-3698,共4页Chinese Journal of Nosocomiology

基　　金：天津市科技计划基金资助项目(2016087)

摘　　要：目的探讨影响心脏搭桥手术患者术后感染因素,并制定预防措施。方法选择2013年6月-2016年6月在医院接受心脏搭桥手术治疗的3 498例患者,采集术后感染患者血液、伤口分泌物、尿液、咽拭子、组织液等标本进行细菌培养、鉴定及药敏试验,并对影响心脏搭桥手术患者术后感染因素进行分析。结果 3 498例患者中有96例发生术后感染,感染率为2.74%;感染部位以手术切口为主,共分离出128株病原菌,其中革兰阳性菌41株占32.03%,革兰阴性菌74株占57.81%,真菌13株占10.16%;金黄色葡萄球菌、粪肠球菌、表皮葡萄球菌对青霉素G、红霉素的耐药率>50.00%,而对万古霉素、利奈唑胺非常敏感;铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌对氨苄西林、头孢曲松具有较高耐药率,对头孢他啶、左氧氟沙星耐药率<50.00%,对亚胺培南、美罗培南、头孢哌酮/舒巴坦非常敏感;年龄≥60岁、有合并症、二次手术、术中出血量≥1 200ml、手术时间>5h、术前住院时间≥7d、胸腔引流时间≥3d、气管插管时间≥3d、导尿管留置时间≥3d、心功能NYHA≥Ⅲ级、切口实施皮下连续缝合、未预防性使用抗菌药物是心脏搭桥手术术后感染的独立危险因素。结论多种因素均可引起心脏搭桥手术患者术后感染,针对相关因素应积极采取有效预防对策,以降低术后感染率。OBJECTIVE To explore the influencing factors for postoperative infections in patients undergoing heart bypass surgery and put forward the prevention measures.METHODS A total of 3 498 patients who received the heart bypass surgery from Jun 2013 to Jun 2016 were enrolled in the study.The blood, wound, urine, throat swab, and interstitial fluid specimens were collected from the patients with postoperative infections and were cultured, the isolated pathogens were identified, the drug susceptibility testing was performed, and the influencing factors for the postoperative infection were analyzed.RESULTS Of the 3 498 patients, 96 had the postoperative infection, with the infections rate 2.74%.The surgical incision was the major infection site.Totally 128 strains of pathogens were isolated, of which 32.03% （41 strains） were gram-positive bacteria, 57.81% （74 strains） were gram-negative bacteria, and 10.16% （13 strains） were fungi.The drug resistance rates of Staphylococcus aureus, Enterococcus faecalis, and Staphylococcus epidermidis to penicillin G and erythromycin were more than 50.00%, however, the strains were highly susceptible to vancomycin and linezolid.The Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae were highly resistant to ampicillin and ceftriaxone, the drug resistance rates to ceftazidime and levofloxacin were less than 50.00%, and the strains were highly susceptible to imipenem, meropenem, and cefoperazone-sulbactam.The independent risk factors for the postoperative infections in the patients undergoing the heart bypass surgery included the no less than 60 years of age, complications, second surgery, intraoperative bleeding volume no less than 1 200ml, operation duration more than 5 hours, preoperative hospitalization duration no less than 7 days, time of chest drainage no less than 3 days, endotracheal intubation time no less than 3 days, urinary catheter indwelling time no less than 3 days, cardiac function NYHA no less than grade Ⅲ, continuous subcutaneous suture of in

关 键 词：手术室 护理 感染 危险因素 防治对策 

分 类 号：R654.2[医药卫生—外科学]