心脏外科术后深部胸骨切口感染患者临床分型及病原学特点研究  

Clinical classification of patients with deep sternal incisions infections after cardiac surgery and etiological characteristics

作　　者：杨平[1] 蒲亨萍[1] 刘榜英[1] 付建红[1] 苏家琼 瞿中承 

机构地区：[1]贵州省遵义市第一人民医院护理部,贵州遵义563002 [2]贵州省遵义市第一人民医院心胸外科,贵州遵义563002

出　　处：《中华医院感染学杂志》2017年第21期4923-4926,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析心脏外科手术后患者深部胸骨切口感染情况,根据临床表现、分型情况及病原学特点进行分析,为预防及治疗感染提供临床依据。方法选取2013年1月-2016年11月医院心脏外科收治的172例术后感染患者为研究对象,对患者发生术后深部胸骨切口感染率进行统计,并分析患者发生感染的临床表现分型及病原学特点。结果 172例心脏外科术后感染患者中有81例发生深部胸骨切口感染,其中Ⅰ型19例占23.46%,Ⅱ型45例占55.56%、Ⅲ型17例占20.99%;81例深部胸骨切口感染患者共检出病原菌146株,其中革兰阴性菌79株占54.11%、、革兰阳性菌56株占38.36%、真菌11株占7.53%;铜绿假单胞菌、大肠埃希菌和鲍氏不动杆菌对亚胺培南、头孢哌酮和哌拉西林的耐药率较低、对头孢他啶和庆大霉素耐药率较高;金黄色葡萄球菌和表皮葡萄球菌对万古霉素、替考拉宁的耐药率较低,对青霉素G、克林霉素的耐药率较高。结论心脏外科手术后患者发生深部胸骨切口感染临床表现一般较为典型,临床以Ⅱ型常见,革兰阴性菌及金黄色葡萄球菌和表皮葡萄球菌是导致术后切口感染的主要致病菌,临床治疗应根据药敏试验合理选择抗菌药物治疗。OBJECTIVE To analyze the prevalence of deep thoracic incision infections after the cardiac surgery and observe the clinical manifestations,classification and etiological characteristics so as to provide guidance for prevention and treatment of the infections.METHODS A total of 172 patients who underwent the cardiac surgery from Jan 2013 to Nov 2016 and had postoperative infections were recruited as the study objects,the incidence of postoperative deep sternal incision infections was statistically analyzed,and the clinical manifestations and etiological characteristics of the patients with infections were observed.RESULTS Of the 172 cardiac surgery patients with postoperative infections,81 had deep thoracic incision infections,of whom 19（23.46%）had typeⅠ deep sternal incision infections,45（55.56%）had typeⅡsternal incision infections,and 17（20.99%）had typeⅢsternal incision infections.Totally 146 strains of pathogens were isolated from the 81 patients with deep sternal incision infections,of which 79（54.11%）were gram-negative bacteria,56（38.36%）were gram-positive bacteria,and 11（7.53%）were fungi.The drug resistance rates of Pseudomonas aeruginosa,Escherichia coli and Acinetobacter baumannii to imipenem,cefoperazone and piperacillin were low,and the drug resistance rates to ceftazidime and gentamicin were high.The drug resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to vancomycin and teicoplanin were low,and the drug resistance rates to penicillin G and clindamycin were high.CONCLUSIONThe cardiac surgery patients with postoperative deep sternal incision infection have typical clinical manifestations,the typeⅡ deep sternal incision infection is the most common clinical manifestation.The gramnegative bacteria,S.aureus and S.epidermidis are dominant among the pathogens causing the postoperative incision infections.It is necessaryfor the hospital to reasonably use antibiotics based on the drug susceptibility testing.

关 键 词：心脏外科手术 深部胸骨切口感染 临床分型 临床表现 病原学特点 

分 类 号：R654.2[医药卫生—外科学]