老年患者心脏术后感染的病原菌分布及危险因素分析  

The Distribution and Risk Factors of Postoperative Infections in Elderly Patients with Cardiac Surgery

作　　者：刘朝军 王凯飞[2] 苏猛[3] LIU Chaojun;WANG Kaifei;SU Meng(Mudanyuan Clinic,Beijing Urban Construction Group,Beijing 100083,China;Chinese PLA General Hospital,Beijing 102600,China;Beijing Daxing Hospital, Capital Medical University, Beijing 102600,China)

机构地区：[1]北京城建集团牡丹园门诊部,北京100083 [2]解放军总医院,北京100853 [3]首都医科大学北京大兴医院,北京102600

出　　处：《标记免疫分析与临床》2021年第5期805-809,共5页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金面上项目(编号:81670005)。

摘　　要：目的探讨老年患者心脏术后感染的危险因素及病原菌分布,为临床防控措施的制定提供参考依据。方法分析2015年6月至2020年6月在我院心脏术后老年患者的临床资料,根据患者是否发生切口感染分为观察组和对照组。比较两组患者的临床资料及病原菌分布情况,通过Logistic回归分析确定影响患者切口感染的独立危险因素。结果421例患者术后发生切口感染的有87例,感染率为20.67%。感染部位以深部手术切口感染为主,占56.32%。分离出的95株菌株中革兰氏阳性菌占48.42%,主要为金黄色葡萄球菌和表皮葡萄球菌。革兰氏阴性菌占47.37%,主要为铜绿假单胞菌和鲍曼不动杆菌。单因素分析显示,BMI、吸烟、糖尿病、COPD、低蛋白血症、激素用药史、失血量、输血量、手术时间、呼吸机佩戴天数及ICU天数与患者是否发生切口感染有关。多因素Logistic回归分析显示,COPD、低蛋白血症、激素用药史、手术时间、呼吸机佩戴天数是患者发生切口感染的独立危险因素。结论老年患者心脏术后切口感染率较高,导致患者感染的危险因素较多,临床上应对患者术后切口的变化进行密切观察,对独立危险因素及主要致病菌进行相应的预防和控制措施制定,以降低患者感染情况的发生。Objective To analyze the risk factors and pathogenic bacteria distribution of incision infections in elderly patients after cardiac surgery,in order to provide a reference for the development of clinical prevention and control measures.Methods The clinical data of elderly patients undergoing open heart surgery from 2015 to 2020 were retrospectively analyzed.According to whether the patients had incision infections,they were divided into the observation group and control group.The clinical data and pathogen distribution of the two groups were compared,and the independent risk factors of perioperative incision infections were determined by logistic regression analysis.Results There were 87 cases of incision infections among 421 patients,with the infection rate 20.67%.The main infection site was deep incision infection(56.32%).Among the 95 strains isolated,48.42%were Gram-positive bacteria,mainly Staphylococcus aureus and Staphylococcus epidermidis,while Gram-negative bacteria accounted for 47.37%,mainly Pseudomonas aeruginosa and Acinetobacter baumannii.Univariate analysis showed that BMI,smoking,diabetes mellitus,COPD,hypoproteinemia,history of hormone use,blood loss,blood transfusion volume,operation time,ventilator wearing days and ICU days were related to incision infections.Multivariate logistic regression analysis showed COPD,hypoproteinemia,history of hormone use,time of operation and the number of days the ventilator was worn were all independent risk factors for perioperative incision infection.Conclusion The perioperative incision infection rate is higher in elderly patients after cardiac surgery and there are multiple risk factors for infections.Therefore,the changes of perioperative incision should be closely observed in the clinical practice,and corresponding prevention and control measures should be formulated targeting independent risk factors and main pathogens,so as to reduce the incidence of infections in patients.

关 键 词：老年 心脏术后 感染 

分 类 号：R592[医药卫生—老年医学]