胸外科围手术期抗生素的规范使用与术后感染病原菌耐药性分析  

Standardized use of antibiotics in perioperative period of thoracic surgery and analysis of drug resistance of postoperative infection pathogens

作　　者：周会 蔡鹏 周维富 彭俊华 蒲亨景 ZHOU Hui;CAI Peng;ZHOU Wei-fu;PENG Jun-hua;PU Heng-jing(Operating Room,Zunyi First People's Hospital,Zunyi Guizhou 563000,China)

机构地区：[1]遵义市第一人民医院暨遵义医科大学第三附属医院手术室,贵州遵义563000

出　　处：《现代预防医学》2020年第10期1892-1895,共4页Modern Preventive Medicine

基　　金：贵州省卫生计生委科学技术基金项目(gzwjkj2018084)。

摘　　要：目的探讨胸外科围手术期抗生素的规范使用与术后感染病原菌耐药性。方法选取医院胸外科手术执行预防用药规范后6个月住院并接受手术治疗的52例患者作为观察组,另选取规范执行前1年同期(2017年6月-2017年12月)的52例患者作为对照组,采用t检验和χ2检验,比较两组围手术期抗生素使用情况、住院治疗时间,患者用药后炎症因子改善情况及用药不良反应情况。分析胸外科术后感染口感染病原菌分布及耐药性。结果观察组抗生素使用时间(35.14±6.28)h、住院时间(9.27±1.35)d、抗生素费用(1352.37±245.69)元,均低于对照组(t=6.756,6.176,18.061,P<0.001);两组术后各炎性因子水平均出现明显升高,但观察组术后hs-CRP、IL-6等炎性因子水平均低于对照组(t=8.667,23.992,12.478,P<0.001);观察组并发症发生率为7.69%,低于对照组的23.08%;差异有统计学意义(χ2=4.727,P<0.05)。两组患者共发生术后感染16例,共培养出20株病原菌,常见病原菌有金黄色葡萄球菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌和鲍曼不动杆菌。凝固酶阴性葡萄球菌、金黄色葡萄球菌均对万古霉素敏感,对青霉素G、阿莫西林的耐药菌均超过70%;肺炎克雷伯菌、鲍曼不动杆菌均对亚胺培南敏感,对头孢曲松、头孢哌酮、头孢唑林均高度耐药。结论对胸外科手术围术期执行抗生素规范使用管理,可有效控制患者术后炎性因子水平及术后感染发生率;针对术后感染病原菌的耐药情况,应合理选择抗菌药物,以提高抗感染治疗效果,降低耐药风险。Objective The aim of this study was to investigate the standard use of antibiotics in perioperative period of thoracic surgery and the drug resistance of postoperative infection pathogens.Methods A total of 52 patients,who received standard surgery guidance for 6 months,hospitalized and underwent thoracic surgery in our hospital,were chosen as observation group.52 patients were used as the control group.The perioperative antibiotic use,hospitalization time,improvement of inflammatory factors and adverse drug reactions were compared between the two groups.The distribution resistance of pathogenic bacteria infected with oral infection after thoracic surgery was analyzed.Results The antibiotic use time(35.14+6.28)h,hospitalization time(9.27+1.35)days,antibiotic cost(1352.37+245.69)yuan in the observation group were lower than those in the control group(t=6.756,6.176,18.061,P<0.001).The levels of inflammatory factors in the two groups increased significantly after operation,but the levels of hs-CRP and IL-6 in the observation group were lower than those in the control group(t=8.667,23.992,12.478,P<0.001).The incidence of complications in the observation group was 7.69%,lower than that in the control group(23.08%).The difference was statistically significant(χ2=4.727,P<0.05).A total of 16 cases of postoperative infection occurred in the two groups,and 20 pathogens were cultured.The common pathogens were Staphylococcus aureus,coagulase-negative staphylococci,Klebsiella pneumoniae and Acinetobacter baumannii.Coagulasenegative staphylococci and Staphylococcus aureus were sensitive to vancomycin,and resistant bacteria to penicillin G and amoxicillin were more than 70%.Klebsiella pneumoniae and Acinetobacter baumannii were all imipenem sensitive,and highly resistant to ceftriaxone,cefoperazone,and cefazolin.Conclusion The implementation of antibiotic standard management during the perioperative period of thoracic surgery could effectively control the postoperative inflammatory factor level and the incidence of postoperati

关 键 词：胸外科 手术 围手术期 抗生素 病原菌 耐药 

分 类 号：R378[医药卫生—病原生物学]