结直肠癌术后造口周围感染的病原菌耐药性分析及护理预防对策  

Analysis of Drug Resistance of Pathogenic Bacteria and Nursing Prevention Countermeasures of Peristomal Infection After Colorectal Cancer Surgery

作　　者：白小龙 李谧宁[2] 孙云[2] 屈清荣[1] BAI Xiaolong;LI Mining;SUN Yun;QU Qingrong(Department of General Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China;Department of General Surgery,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710000,Shaanxi,China)

机构地区：[1]郑州大学第一附属医院普通外科,河南郑州450000 [2]西安交通大学第二附属医院普通外科,陕西西安710000

出　　处：《中国药物滥用防治杂志》2022年第12期1772-1775,1788,共5页Chinese Journal of Drug Abuse Prevention and Treatment

摘　　要：目的:探讨结直肠癌术后造口周围感染的病原菌耐药性,并提出相应的护理预防对策。方法:选取2020年1月—2022年1月本院结直肠癌行肠造口手术患者80例开展横断面调查研究,统计术后造口感染发生率,并分析其耐药性;根据是否感染分为感染组、未感染组,对其感染的相关因素进行Logistic回归分析,并探讨护理预防对策。结果:80例术后造口患者中有21例发生造口周围感染(26.25%),共分离出病原菌46株,其中革兰阴性菌、革兰阳性菌、真菌的构成比依次为63.04%、26.09%、10.87%;经单因素分析,感染组在年龄、术中是否冲洗、肠梗阻、合并基础疾病及抗菌药物使用方面与非感染组比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析显示,合并肠梗阻、合并基础疾病及抗菌药物使用种类≥3种为结直肠癌术后造口感染的独立危险因素。结论:结直肠癌术后造口周围易发生感染,主要病原菌是革兰氏阴性菌,对亚胺培南、阿米卡星、头孢哌酮具有较高耐药性,需根据患者实际情况合理选用药物治疗,加强造口护理及围术期护理干预以预防或降低造口周围感染的发生。Objective: To explore the drug resistance of pathogenic bacteria around stoma infection after colorectal cancer operation, and put forward corresponding nursing prevention countermeasures. Methods: A cross-sectional study was conducted on 80 patients with colorectal cancer who underwent enterostomy in our hospital from January 2020 to January 2022 to calculate the incidence of postoperative stoma infection and analyze their drug resistance. According to whether they were infected, they were divided into infected group and uninfected group. Logistic regression analysis was performed on the related factors of infection, and nursing prevention countermeasures were discussed. Results: Among the 80 patients with postoperative stoma, 21 cases(26.25%) had peristomal infection. A total of 226 strains of pathogenic bacteria were isolated, among which Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 63.04%, 26.09% and 10.87%,respectively. Univariate analysis showed that there were statistically significant differences in age, intraoperative irrigation,intestinal obstruction, underlying diseases and use of antibiotics between the infection group and the non-infection group(P<0.05). Multivariate logistic regression analysis showed that combined intestinal obstruction, combined underlying diseases and types of antibiotics ≥ 3 were independent risk factors for stoma infection after colorectal cancer surgery. Conclusion:Infection is prone to occur around the stoma after colorectal cancer surgery. The main pathogenic bacteria are Gram-negative bacteria, which have high resistance to imipenem, amikacin and cefoperazone. It is necessary to rationally select drug treatment according to the actual situation of patients, and strengthen stoma nursing and perioperative nursing intervention to prevent or reduce the occurrence of infection around the stoma.

关 键 词：结直肠癌 感染 耐药性 护理对策 

分 类 号：R473.73[医药卫生—护理学]