血管外科移植物感染的现状与对策  

Current situation and strategy of vascular graft infection

作　　者：辛世杰[1] 史潇兮 崔俊风 XIN Shi-jie;SHI Xiao-xi;CUI Jun-feng(Department of Vascular Surgery,the First Hospital of China Medical University,Regenerative Medicine Research Center,China Medical University,Key Laboratory of Etiology and Prevention of Arterial Diseases of Liaoning Province,Shenyang 110001,China;不详)

机构地区：[1]中国医科大学附属第一医院血管外科中国医科大学再生医学研究中心辽宁省动脉瘤疾病病因及防治研究重点实验室,辽宁沈阳110001 [2]丹东市中心医院普外二科,辽宁丹东118000

出　　处：《中国实用外科杂志》2024年第12期1351-1353,1388,共4页Chinese Journal of Practical Surgery

基　　金：辽宁省科学技术计划项目(No.2022JH1/10400002)。

摘　　要：血管外科移植物的应用已有近百年历史,虽然抗生素的预防应用及手术过程中的无菌程序使得血管移植物或腔内移植物感染(VGEI)的发生率处于较低水平,但因其诊治的复杂性及困难性,VGEI仍是血管外科中致死率较高且充满挑战的并发症。VGEI的发生率可因手术方式、手术部位、移植物种类的不同而有所区别,致病菌的种类在不同地域之间亦存在较大差异。宏观层面,VGEI的发生原因包括术中清创不彻底、术后抗感染治疗不规范、免疫能力减退导致机会致病菌移位感染及医源性因素等;而在微观层面,不同种类及不同载量的致病菌所表现出的毒性、抗药性和对移植物的黏附力等因素也不尽相同,使得VGEI的机制更加复杂。长久以来,因医生个体经验的不同,造成了VGEI诊断效能的差异性,MAGIC分级的提出进一步规范了诊断标准,提高了系统性和一致性。而在治疗方面,精准抗感染治疗是基础,彻底清除感染灶及坏死组织是关键。未来,期望可以更早期、精准地预防和诊断VGEI,并能利用更具抗感染能力的人工材料,通过更有效且微创的治疗手段,改善VGEI病人的预后。The application of vascular grafts has a history of nearly a century.Although the prophylactic use of antibiotics and sterile procedures during surgery have resulted in a low incidence of vascular graft/endovascular graft infection(VGEI),it still represents a highly lethal and challenging complication in vascular surgery due to its complexity and difficulty in diagnosis and treatment.The incidence of VGEI may vary depending on the surgical methods,surgical sites,and types of grafts,and there are also significant differences in the types of pathogenic bacteria among different regions.At the macro level,the causes of VGEI include incomplete intraoperative debridement,non-standard postoperative antiinfective treatment,decreased immune function leading to opportunistic pathogen translocation infection,and iatrogenic factors;At the micro level,the toxicity,drug resistance,and adhesion to grafts exhibited by different types and loads of pathogens also vary,making the mechanism of VGEI more complex.For a long time,the differences in diagnostic efficacy of VGEI have been caused by the varying experiences of doctors,and the MAGIC classification standardizes diagnostic criteria and improves systematicity and consistency.In terms of treatment,precise anti-infective therapy is the foundation,and thorough removal of infected lesions and necrotic tissue is the key.In the future,we hope to prevent and diagnose VGEI earlier and more accurately,and improve the prognosis of VGEI patients through more effective and minimally invasive treatment methods.

关 键 词：血管外科 血管移植物感染 腔内移植物感染 致病菌 抗感染治疗 开放手术 

分 类 号：R6[医药卫生—外科学]