老年胃癌患者术后切口感染病原学特点及其与胃黏膜病理变化、营养状态的关系  

Etiological characteristics of postoperative incision infection in elderly patients with gastric cancer and its relationship with pathological changes of gastric mucosa and nutritional status

作　　者：罗振凌[1] 顾群浩[1] 陈徽[1] LUO Zhenling;GU Qunhao;CHEN Hui(Department of Gastrointestinal Surgery,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院胃肠外科,上海200437

出　　处：《医学研究与战创伤救治》2023年第4期388-393,共6页Journal of Medical Research & Combat Trauma Care

摘　　要：目的分析老年胃癌患者术后切口感染病原学特点及其与胃黏膜病理变化和营养状态的关系。方法回顾性分析2017年6月—2022年6月于上海中医药大学附属岳阳中西医结合医院接受手术治疗的350例老年胃癌病例临床资料。统计其切口感染情况并分析切口感染的病原学特点。依据感染发生情况将研究对象分为感染组和未感染组,分析其危险因素及与胃黏膜病理变化、营养状态的关系。结果老年胃癌患者术后切口感染率为7.14%(25/350);25例感染患者共分离培养出病原菌38株,包括革兰阴性菌20株(52.64%)、革兰阳性菌15株(39.47%)和真菌3株(7.89%)。大肠埃希菌、铜绿假单胞菌在革兰阴性菌中较常见,革兰阳性菌中以金黄色葡萄球菌为主。主要革兰阴性菌大肠埃希菌、铜绿假单胞菌对各类常用抗菌药物(氨苄西林、哌拉西林、头孢呋辛、头孢曲松、头孢唑林、四环素、环丙沙星)的耐药性均较高;主要革兰阳性菌金黄色葡萄球菌对常见抗菌药物青霉素G、四环素、克林霉素耐药率分别为100.00%、80.00%、80.00%,对万古霉素、利奈唑胺耐药率均为0。高龄(OR=1.415,95%CI=1.127~1.776,P=0.003)、糖尿病史(OR=1.514,95%CI=1.017~2.254,P=0.042)、开腹手术(OR=1.279,95%CI=1.057~1.547,P=0.012)、术前胃黏膜病理评分高(OR=1.687,95%CI=1.107~2.571,P=0.015)及营养风险(OR=1.346,95%CI=1.081~1.676,P=0.008)为老年胃癌患者术后发生切口感染的独立危险因素(P<0.05)。老年胃癌患者术后切口感染与胃黏膜病理评分、NRS2002评分呈正相关(r=0.489、0.625,均P<0.05)。结论老年胃癌患者术后切口感染率高,且分离的病原菌以革兰阴性菌为主,耐药形势严峻。切口感染也与高龄、有糖尿病、开腹手术、术前胃黏膜病理变化、术前营养状态差有一定关联,需采取预防性措施。Objective To analyze the etiological characteristics of postoperative incision infection in elderly patients with gastric cancer,and its relationship with pathological changes of gastric mucosa and nutritional status.Methods A retrospective analysis was conducted among the 350 elderly patients who had undergone gastric cancer surgery.The status of incision infection and the etiological characteristics of the infection were analyzed.According to the presence or absence of incision infection,the patients were divided into infected group and uninfected group.The relationship among the risk factors of incision infection,the pathological changes of gastric mucosa and the nutritional status were analyzed.Results The incidence of postoperative incision infection in this study was 7.14%(25/350).A total of 38 pathogen strains were isolated from the 25 infected patients,including 20(52.64%)strains of Gram-negative bacteria,15(39.47%)strains of Gram-positive bacteria and 3(7.89%)strains of fungi.Gram-negative bacteria mainly included Escherichia coli and Pseudomonas aeruginosa.Gram-positive bacteria mainly included Staphylococcus aureus.The main Gram-negative bacteria(Escherichia coli and Pseudomonas aeruginosa)were highly resistant to commonly used antibiotics(ampicillin,piperacillin,cefuroxime,ceftriaxone,cefazolin,tetracycline and ciprofloxacin).The resistance rates of main Gram-positive bacteria(Staphylococcus aureus)to penicillin G,tetracycline and clindamycin were 100.00%,80.00%and 80.00%,while the resistance rates to vancomycin and linezolid were both zero.Advanced age(OR=1.415,95%CI=1.127-1.776,P=0.003),history of diabetes(OR=1.514,95%CI=1.017-2.254,P=0.042),laparotomy(OR=1.279,95%CI=1.057-1.547,P=0.012),high pathological score of gastric mucosa before operation(OR=1.687,95%CI=1.107-2.571,P=0.015)and nutritional risk(OR=1.346,95%CI=1.081-1.676,P=0.008)were independent risk factors for postoperative incision infection in elderly patients with gastric cancer(P<0.05).Analysis showed that postoperative incision infectio

关 键 词：老年 胃癌 切口感染 病原学特点 胃黏膜病理 营养状态 

分 类 号：R735.2[医药卫生—肿瘤]