小儿心脏外科术后并发肺部感染细菌学分析  

Bacteriological analysis of pulmonary infection after pediatric cardiac surgery

作　　者：吴亚楠 杨龙叶 李晓琴 王继宏 WU Yanan;YANG Longye;LI Xiaoqin;WANG Jihong(DepartmentofCardiology,XingtaiCentral Hospital,Xingtai 054000,Hebei,China;CCU of Xingtai Central Hospital;Department of Anesthesiology,XingtaiCentral Hospital)

机构地区：[1]邢台市中心医院心外科,河北邢台054000 [2]邢台市中心医院心内CCU [3]邢台市中心医院麻醉科

出　　处：《中国病原生物学杂志》2024年第12期1487-1491,共5页Journal of Pathogen Biology

摘　　要：目的 探讨小儿心脏外科术后并发肺部感染的细菌学特征,并评估PDCA(Plan-Do-Check-Act)护理模式在预防和控制术后肺部感染中的应用效果,以期为临床提供更有效的护理策略。方法 本研究以400例心脏外科手术治疗患儿为研究对象,收集患儿临床资料、实验室检查结果及细菌培养结果,对肺部感染的细菌学特征进行描述性分析。同时,将患儿随机分为观察组和对照组,对照组患儿接受常规护理,而观察组患儿则在常规护理基础上实施PDCA护理模式。两组患儿在术后肺部感染的发生率、机械通气时间、术后住院时间等方面进行比较。结果 在400例患儿中,26例(6.5%)心脏外科术后并发肺部感染。共检出26株病原菌,其中革兰阴性菌18株(69.23%),革兰阳性菌8株(30.77%)。革兰阴性菌主要包括鲍曼不动杆菌、肺炎克雷伯菌、流感嗜血杆菌等;革兰阳性菌则包括金黄色葡萄球菌、肺炎链球菌等。革兰阴性菌感染组患儿体内的血清C反应蛋白(CRP)水平呈现出(15.17±6.71)mg/L的平均值,而肿瘤坏死因子-α(TNF-α)的数值则为(38.67±5.26)ng/L,另外,白介素-6(IL-6)的浓度也达到了(39.41±7.16)ng/L。相比之下,革兰阳性菌感染组患儿的血清CRP水平为(14.38±5.39)mg/L,TNF-α水平为(35.34±6.20)ng/L,而IL-6的水平则为(35.27±9.39)ng/L。革兰阴性菌感染组患儿血清CRP、TNF-α以及IL-6的水平均略高于革兰阳性菌感染组的患儿,但差异无统计学意义(P>0.05)。革兰阴性菌对头孢噻肟、头孢他啶、庆大霉素、环丙沙星、左氧氟沙星的耐药率高于50%,对阿米卡星、亚胺培南、美罗培南的耐药率低于30%。革兰阳性菌对青霉素、红霉素、克林霉素的耐药性高于50%,对莫西沙星、利福平的耐药率低于30%,未产生对万古霉素、替考拉宁的耐药株。观察组患儿术后并发肺部感染率为1.50%(3/200),对照组患儿术后并发肺部感染率为11.50%(23/200),两组患儿Objective This study explored the bacteriological characteristics of pulmonary infection after pediatric cardiac surgery and evaluated the application effect of the PDCA(Plan-Do-Check-Act)nursing model in preventing and controlling postoperative pulmonary infection,with the aim of providing more effective nursing strategies for clinical practice.Methods This study retrospectively analyzed a total of 400 children who underwent surgical treatment in the cardiac surgery department of our hospital.By collecting the clinical data,laboratory test results and bacterial culture results of the children,a descriptive analysis of the bacteriological characteristics of pulmonary infection was conducted.Meanwhile,the children were randomly divided into the observation group and the control group.The children in the control group received conventional nursing,while the children in the observation group implemented the PDCA nursing model on the basis of conventional nursing.The incidence of postoperative pulmonary infection,mechanical ventilation time,and postoperative hospital stay of the two groups of children were compared.Results Among the 400 children,26 cases(6.5%)developed pulmonary infection after cardiac surgery.A total of 26 pathogenic bacteria were detected,among which 18 strains(69.23%)were Gram-negative bacteria and 8 strains(30.77%)were Gram-positive bacteria.Gramnegative bacteria mainly included Acinetobacter baumanni,Klebsiella pneumoniae,Haemophilus influenzae,etc.;Gram-positive bacteria included Staphylococcus aureus,Streptococcus pneumoniae,etc.In the Gram-negative bacteria infection group,the average value of serum C-reactive protein(CRP)level in children was(15.17±6.71)mg/L,the value of tumor necrosis factor-α(TNF-α)was(38.67±5.26)ng/L,and the concentration of interleukin-6(IL-6)also reached(39.41±7.16)ng/L.In contrast,in the Gram-positive bacteria infection group,the serum CRP level of children was(14.38±5.39)mg/L,the TNF-αlevel was(35.34±6.20)ng/L,and the IL-6 level was(35.27±9.39)ng/L.The levels

关 键 词：心脏外科手术 肺部感染 病原菌 PDCA循环护理法 

分 类 号：R726.5[医药卫生—儿科]