心脏搭桥手术患者术后感染因素分析与预防

发布时间：2018-06-20 14:08

  本文选题：手术室 + 护理　； 参考：《中华医院感染学杂志》2017年16期

【摘要】：目的探讨影响心脏搭桥手术患者术后感染因素,并制定预防措施。方法选择2013年6月-2016年6月在医院接受心脏搭桥手术治疗的3 498例患者,采集术后感染患者血液、伤口分泌物、尿液、咽拭子、组织液等标本进行细菌培养、鉴定及药敏试验,并对影响心脏搭桥手术患者术后感染因素进行分析。结果 3 498例患者中有96例发生术后感染,感染率为2.74%;感染部位以手术切口为主,共分离出128株病原菌,其中革兰阳性菌41株占32.03%,革兰阴性菌74株占57.81%,真菌13株占10.16%;金黄色葡萄球菌、粪肠球菌、表皮葡萄球菌对青霉素G、红霉素的耐药率50.00%,而对万古霉素、利奈唑胺非常敏感;铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌对氨苄西林、头孢曲松具有较高耐药率,对头孢他啶、左氧氟沙星耐药率50.00%,对亚胺培南、美罗培南、头孢哌酮/舒巴坦非常敏感;年龄≥60岁、有合并症、二次手术、术中出血量≥1 200ml、手术时间5h、术前住院时间≥7d、胸腔引流时间≥3d、气管插管时间≥3d、导尿管留置时间≥3d、心功能NYHA≥Ⅲ级、切口实施皮下连续缝合、未预防性使用抗菌药物是心脏搭桥手术术后感染的独立危险因素。结论多种因素均可引起心脏搭桥手术患者术后感染,针对相关因素应积极采取有效预防对策,以降低术后感染率。
[Abstract]:Objective to investigate the factors affecting postoperative infection in patients undergoing cardiac bypass grafting and to make preventive measures. Methods from June 2013 to June 2016, 3 498 patients underwent cardiac bypass surgery in hospital. Blood, wound secretion, urine, pharynx swab and tissue fluid were collected for bacterial culture, identification and drug sensitivity test. The influencing factors of postoperative infection in patients undergoing cardiac bypass grafting were analyzed. Results 96 out of 3 498 patients had postoperative infection, the infection rate was 2.74.The infection site was mainly surgical incision, 128 strains of pathogenic bacteria were isolated. Among them, 41 Gram-positive bacteria accounted for 32.03, 74 Gram-negative bacteria accounted for 57.81 and 13 fungi accounted for 10.16.The resistance rate of Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis to penicillin G and erythromycin was 50.00. Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae showed high resistance to ampicillin and ceftriaxone, and 50.00to ceftazidime and levofloxacin, sensitive to imipenem, meropenem, cefoperazone / sulbactam; Age 鈮，

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