老年瓣膜病患者心瓣膜置换术后感染预防的临床研究

发布时间：2018-12-25 11:54

【摘要】：目的探讨老年瓣膜病患者实施心瓣膜置换术后感染预防的方法,以降低术后感染率。方法选取2011年1月-2012年4月医院收治的行心瓣膜置换术老年瓣膜病患者112例,将其随机分为对照组55例和观察组57例,对照组围术期采用常规措施进行术后感染预防,观察组围术期采用综合干预措施预防术后感染,比较两组患者术后感染率。结果两组患者主动脉阻断时间差异无统计学意义;观察组患者机械通气、麻醉清醒、ICU停留、饮食恢复及住院时间均明显短于对照组;两组患者在手术开始后肿瘤坏死因子(TNF-α)、白介素-6(IL-6)以及白介素-10(IL-10)血浆含量均明显升高,至停机1h达高峰,停机24h下降,但仍高于麻醉诱导前;观察组患者TNF-α、IL-6上述时刻血浆含量明显高于对照组,IL-10明显低于对照组;两组患者于术后1d和5d时肌酸激酶同工酶(CK-MB)以及cTnT水平均明显高于麻醉诱导前,且对照组患者明显高于观察组;观察组患者术后共有1例发生术后感染,感染率为1.75%,对照组患者术后共有4例发生感染,感染率为7.27%,两组比较差异有统计学意义(P0.05)。结论老年患者行心瓣膜置换术后机体受到的损伤较大,恢复也较慢,易发生术后感染,因此在围手术期给予患者综合干预措施,可以降低患者术后感染率,提升患者恢复效率,提高手术治疗质量。
[Abstract]:Objective to investigate the prevention of postoperative infection in elderly patients with valvular valve replacement and to reduce the postoperative infection rate. Methods 112 patients with valvular valve replacement were randomly divided into control group (55 cases) and observation group (57 cases). The control group was treated with routine measures to prevent postoperative infection during perioperative period. In the observation group, comprehensive intervention was used to prevent postoperative infection, and the infection rate was compared between the two groups. Results there was no significant difference in aortic occlusion time between the two groups, and the observation group was significantly shorter than the control group in terms of mechanical ventilation, awake anesthesia, ICU stay, diet recovery and hospital stay. The plasma levels of tumor necrosis factor (TNF- 伪), interleukin-6 (IL-6) and interleukin-10 (IL-10) were significantly increased in both groups after operation, and reached the peak at 1 hour after operation, and decreased at 24 h after operation. But it was still higher than that before anesthesia induction. The plasma levels of TNF- 伪 and IL-6 in the observation group were significantly higher than those in the control group and IL-10 was significantly lower than that in the control group. The levels of creatine kinase isoenzyme (CK-MB) and creatine kinase (cTnT) were significantly higher in both groups on the 1st and 5th day after operation than before anesthesia induction, and those in the control group were significantly higher than those in the observation group. There was 1 case of postoperative infection in the observation group and 4 cases in the control group. The infection rate was 7.27. The difference between the two groups was statistically significant (P0.05). Conclusion the elderly patients after cardiac valve replacement have more injury, slower recovery and more easily infection after operation. Therefore, comprehensive intervention measures in perioperative period can reduce the postoperative infection rate and improve the recovery efficiency of the patients. Improve the quality of surgical treatment.
【作者单位】：郑州大学第一附属医院心脏外科;河南南阳医专第一附属医院心脏外科;
【基金】：河南省卫生厅基金资助项目(HW-2009B-021)
【分类号】：R654.2

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