肝癌患者肝切除术后感染病原菌及危险因素分析  

Risk factors for postoperative infection in liver cancer patients undergoing hepatectomy and distribution of pathogens

作　　者：陈建宇[1] 刘志[1] 谢亮[1] 钟扬[1] 兰川[1] CHEN Jian-yu;LIU Zhi;XIE Liang;ZHONG Yang;LAN Chuan(Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院肝胆外二科,四川南充637000

出　　处：《中华医院感染学杂志》2020年第15期2339-2342,共4页Chinese Journal of Nosocomiology

基　　金：四川省卫生和计划生育委员会科研基金资助项目(17PJ106)。

摘　　要：目的探讨肝癌患者肝切除术后感染病原菌分布及危险因素。方法选取2014年1月-2019年1月川北医学院附属医院收治的170例行肝切除术治疗的肝癌患者为研究对象。根据其是否发生术后感染分为感染组(28例)以及未感染组(142例)。分析感染组患者病原菌分布,单因素及多因素分析影响术后感染的危险因素。结果170例肝癌患者行肝切除术后并发感染的28例,感染率为16.47%,以肺部感染为主11例占39.29%,其次为腹腔感染7例占25.00%、手术切口感染6例占21.43%以及泌尿系统感染4例占14.29%。感染组共分离出菌株53株,其中革兰阴性菌29株占54.72%,以大肠埃希菌为主,革兰阳性菌18株占33.96%,以肺炎链球菌为主,其次为金黄色葡萄球菌,真菌6株占11.32%,以白假丝酵母为主。多因素Logistic回归分析显示,年龄大、合并糖尿病、血清白蛋白低以及手术时间长、引流管放置时间和住院时间长为肝癌患者肝切除术后并发感染的独立危险因素(P<0.05)。结论肝癌患者肝切除术后医院感染发生率较高且影响因素较多,可针对其病原菌分布应用抗生素,并对独立危险因素进行控制。OBJECTIVE To explore the infection status,pathogen distribution and risk factors in patients with liver cancer after hepatectomy.METHODS Between Jan.2014 and Jan.2019,170 patients with liver cancer treated with hepatectomy were recruited.According to whether the postoperative infection occurred or not,they were divided into the infection group(28 cases)and the non-infection group(142 cases).The distribution of pathogenic bacteria in the infection group was analyzed,and univariate and multivariate analysis were carried out to explore the risk factors of the infection.RESULTS 28 of 170 patients with liver cancer were complicated with infection after hepatectomy,the infection rate was 16.47%,mainly pulmonary infection 11 cases(39.29%),followed by abdominal infection in 7 cases(25.00%),wound infection in 6 cases(21.43%)and urinary system infection in 4 cases(14.29%).A total of 53 strains were isolated from the infection group,including 29 strains of Gram-negative bacteria(54.72%),mainly Escherichia coli,18 strains of Gram-positive bacteria(33.96%),mainly Streptococcus pneumoniae,followed by Staphylococcus aureus,fungi 6 strains(11.32%),mainly Candida albicans.Multivariate logistic regression analysis showed that age,diabetes mellitus,low serum albumin,long operation time,drainage tube placement time and hospitalization time were independent risk factors for hepatectomy and infection in patients with liver cancer(P<0.05).CONCLUSION The incidence of nosocomial infections after hepatectomy in liver cancer patients was high and there were many influencing factors.Antibiotics can be applied to the distribution of pathogens and the independent risk factors of concurrent infection after hepatectomy in liver cancer patients can be controlled.

关 键 词：肝癌 肝切除术 术后感染 病原菌分布 LOGISTIC回归分析 

分 类 号：R619.3[医药卫生—外科学]