77例心脏外科术后感染患者危险因素的相关分析  

Correlation analysis of risk factors in 77 patients with infection after cardiac surgery

作　　者：徐姗 曹雅青[2] 李培军[2] 李冠华[3] 吴雪[3] 朱泽[1] XU Shan;CAO Yaqing;LI Peijun;LI Guanhua;WU Xue;ZHU Ze(Department of Pathogenic Biology,Tianjin Medical University,Tianjin 300070,China;Department of Blood Transfusion,Tianjin Municipal Chest Hospital,Tianjin 300051,China;Department of Infection Management,Tianjin Municipal Chest Hospital,Tianjin 300051,China)

机构地区：[1]天津医科大学病原生物学系,300070 [2]天津市胸科医院输血科,300051 [3]天津市胸科医院感染管理科,300051

出　　处：《重庆医学》2020年第9期1395-1399,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81672650);天津市医院协会医院管理研究项目(2018zz07)。

摘　　要：目的探究心脏外科手术术后感染的危险因素及病原菌的耐药情况。方法选择2015年1月至2018年12月天津市胸科医院共进行心外科手术的患者8435例,将其中发生术后感染的77例患者作为观察组,依性别、年龄和术式配比选取未发生术后感染的患者200例作为对照组。对两组患者的临床资料进行术后切口感染危险因素分析,同时对观察组进行药敏试验分析病原菌的耐药情况。结果8435例患者中术后感染率为0.91%(77/8435),77例术后感染患者中表浅手术切口感染31例(40.26%),深部手术切口感染32例(41.56%),器官(或腔隙)感染14例(18.18%)。与对照组相比,观察组患者在吸烟、BMI、血糖水平、术前住院时间、手术时间、输血量、气管插管和总住院时间等方面比较,差异均有统计学意义(P<0.05)。吸烟(OR=10.306,95%CI:3.264~32.538,P<0.05)、BMI(OR=0.759,95%CI:0.658~0.877,P<0.05)、手术时间(OR=0.989,95%CI:0.980~0.998,P<0.05)和总住院时间(OR=0.826,95%CI:0.778~0.877,P<0.05)是心脏外科手术术后切口感染的独立危险因素。共检出致病菌51株,其中革兰阳性菌有33株(64.71%),革兰阴性菌17株(33.33%),真菌(白色假丝酵母菌)1株(1.96%)。表皮葡萄球菌和金黄色葡萄球菌对青霉素的耐药率均为100.00%,对克林霉素的耐药率在60.00%以上,但对替加环素、利奈唑胺和万古霉素未表现耐药性;铜绿假单胞菌和鲍曼不动杆菌对头孢唑林和氨苄西林的耐药率均为100.00%。结论心脏外科术后感染的独立危险因素为吸烟史、BMI、手术时间和总住院时间;病原菌以革兰阳性菌为主,并对β-内酰胺类抗生素完全耐药。Objective To investigate the risk factors of infection after cardiac surgery and the drug resistance situation of pathogens.Methods A total of 8435 patients conducted the cardiac surgery in the Tianjin Municipal Chest Hospital from January 2015 to December 2018.Among them,77 cases of postoperative infection served as the observation group,and 200 cases without postoperative infection served as the control group according to the match of gender,age and operation methods.The risk factors analysis of postoperative incision infection was performed on the clinical data in the two groups.At the same time,the drug susceptibility test was performed in the observation group for analyzing the drug resistance situation of pathogens.Results Among 8435 patients,the postoperative infection rate was 0.91%(77/8435).Among 77 cases of postoperative infection,31 cases(40.26%)were superficial surgical incision infection,32 cases(41.56%)were deep surgical incision infection,and 14 cases(18.18%)were organ(or lacunar)infection.Compared with the control group,there were statistically significant differences in smoking,BMI,blood glucose level,preoperative hospital stay,operation time,blood transfusion volume,endotracheal intubation and total hospital stay in the observation group(P<0.05).Smoking(OR=10.306,95%CI:3.264-32.538,P<0.05),BMI(OR=0.759,95%CI:0.658-0.877,P<0.05),operative time(OR=0.989,95%CI:0.980-0.998,P<0.05)and total hospital stay(OR=0.826,95%CI:0.778-0.877,P<0.05)were the independent risk factors for incision infection after cardiac surgery.A total of 51 strains of pathogenic bacteria were detected,including 33 strains(64.71%)of Gram-positive bacteria,17 strains(33.33%)of Gram-negative bacteria,and 1 strain(1.96%)of fungus(candida alba).Both staphylococcus epidermidis and staphylococcus aureus had the 100.00%resistance rate to penicillin and the over 60.00%resistance rate to clindamycin,but showed no resistance to tigecycline,linezolid and vancomycin.The drug resistance rate of pseudomonas aeruginosa and acinetobacter baumann

关 键 词：心脏外科手术 外科伤口感染 危险因素 病原菌 耐药性 

分 类 号：R619.3[医药卫生—外科学]