外科术后院内感染性肺炎、多重耐药菌分布特点和感染因素分析  

Analysis of postoperative pneumonia, distribution characteristics of the multi-drug resistant organism and infection factors after surgery

作　　者：杨芸 孙硕 王亚红 何龙 袁真真 YANG Yun;SUN Shuo;WANG Yahong;HE Long;YUAN Zhenzhen(Department of Laboratory,921 Hospital,Joint Logistics Support Force,Changsha,410003,China)

机构地区：[1]联勤保障部队第921医院检验科,长沙410003

出　　处：《临床血液学杂志》2021年第6期394-398,402,共6页Journal of Clinical Hematology

摘　　要：目的:研究外科患者术后院内感染性肺炎(POP)发生情况和多重耐药菌(MDRO)分布特点,分析术后POP发病的影响因素。方法:选取2017年1月—2019年12月外科手术患者,根据年度、科室、年龄段分别统计术后POP发生率、POP死亡率、MDRO检出率、非MDRO检出率差异。将所有手术患者根据性别、年龄、术前免疫抑制剂使用、手术时机、气管切开与否、呼吸机使用与否、基础疾病有无、手术级别、胃管有无、术后抗生素使用是否合理和使用时间、术中出血量划为不同组别,比较POP发病率,当P<0.05时,纳入多因素Logistic回归分析。结果:7424例手术患者发生POP 82例,发病率1.10%,不同年度POP发病率、POP死亡率、MDRO检出率、非MDRO检出率差异均无统计学意义(均P>0.05);不同科室手术患者POP发病率差异有统计学意义(χ^(2)=52.280,P<0.001);50~75岁、>75岁年龄段术后POP发病率高于0~25岁、25~50年龄段,差异有统计学意义(P<0.05);MDRO以革兰阴性菌(G-)为主,占比最高为鲍曼不动杆菌,其次为铜绿假单胞菌。外科术后发生POP与患者年龄、术前是否使用免疫抑制剂、是否择期手术、气管是否切开、是否有基础疾病、手术级别、术后抗生素使用是否合理有关(均P<0.05);年龄、术前使用免疫抑制剂、非择期手术、气管切开、有基础性疾病、手术级别高、术后未合理使用抗生素均为术后发生POP的危险因素(均P<0.05)。结论:外科POP发病率、死亡率较高,需引起临床高度重视,手术患者中对于年龄大、有基础疾病、使用免疫抑制剂、急诊手术、有气管切开的三、四级手术患者列为重点保护人群,术后科学合理使用抗生素,以降低术后POP发生率和MDRO的产生。Objective: To study the incidence of postoperative pneumonia(POP) and the distribution of multi-drug resistant bacteria(MDRO) in surgical patients, and analyze the influencing factors of POP after surgery. Methods: From January 2017 to December 2019, all surgical patients in the hospital were selected. According to the year, department and age group, the incidence of POP, the mortality rate of POP patients, the detection rate of MDRO and the detection rate of non multi-drug resistant organism, all patients were divided into different groups according to gender, age, use of preoperative immunosuppressive agents, timing of operation, use of tracheotomy, use of ventilator, underlying diseases, grade of operation, use of gastric tube, postoperative antibiotic usage and bleeding volume. The incidence rate of POP was compared in each group. When P<0.05, it was included in the multivariate Logistic regression analysis. Results: A total of 82 cases of POP occurred in 7424 patients, and the incidence rate was 1.10%. There was no significant difference in POP incidence rate in different years, POP mortality rate, MDRO detection rate and non multi-drug resistance organism detection rate(P>0.05). The incidence rate of POP among different surgical departments was statistically significant(χ^(2)=52.280, P<0.001). The incidence of POP in groups of 50-75 years old and>75 years old was higher than that in groups of 0-25 years old and 25-50 years old, the difference was statistically significant(P<0.05). MDRO was mainly G-, the highest proportion was Acinetobacter baumannii, followed by Pseudomonas aeruginosa. The occurrence of POP after surgery was related to the patient’s age, whether to use immunosuppressive agents before surgery, whether to select surgery time, whether to have a tracheotomy, whether there was an underlying disease, the grade of surgery, and whether the use of antibiotics after surgery was reasonable(all P<0.05). Age, preoperative use of immunosuppressive agents, non-selective surgery, tracheotomy, underlyin

关 键 词：术后肺炎 多重耐药菌 发病率 院内感染 感染因素 

分 类 号：R563.1[医药卫生—呼吸系统]