肝叶切除术患者术后感染病原菌及相关因素分析
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摘要
目的分析肝叶切除术患者术后感染病原菌与耐药情况和相关因素。方法回顾性分析2011年1月-2016年12月于医院行肝叶切除术患者258例的临床资料,统计患者术后感染、病原菌及药敏情况,统计患者的术前身体状况及医疗因素,归纳肝叶切除术患者术后感染的相关因素,分析降低肝叶切除术后感染的措施。结果 258例肝叶切除患者术后发生感染28例,感染率10.85%,感染部位以呼吸道和膈下为主,共培养分离病原菌39株,其中革兰阴性菌19株占48.72%,革兰阳性菌12株占30.77%,真菌8株占20.51%;主要革兰阳性菌对万古霉素、利奈唑胺较敏感,而头孢氨苄、头孢拉定耐药率均>50%;主要革兰阴性菌对阿莫西林、头孢曲松、氨苄西林耐药率均>50%,对亚胺培南、美罗培南较敏感;原发疾病(肝癌、胆道肿瘤、肝外伤)、伴慢性疾病、住院时间、营养不良是肝叶切除术患者术后感染的相关因素(P<0.05)。结论肝叶切除术患者术后医院感染率较高,充分做好患者术后管路管理、营养指导及抗菌药物应用,尽可能降低患者术后感染率,提升患者治疗质量。
OBJECTIVE To analyze the risk factors of postoperative infection in patients undergoing hepatectomy,and to explore the measures to reduce the incidence of postoperative infection after hepatectomy,so as to reduce the postoperative infection rate of patients after hepatectomy.METHODS A retrospective analysis was conducted for the clinical data of 258 cases of patients underwent hepatectomy in Affiliated Hospital of Zunyi Medical College from Jan.2011 to Dec.2016.The incidence rate of postoperative infection,composition and drug sensitivity of pathogens,as well as the preoperative physical condition and medical factors of patients were statistically analyzed.The factors related to postoperative infection in patients with hepatectomy were summarized,and the measures to reduce the postoperative infection after hepatectomy were analyzed.RESULTS 28 cases of infection occurred in 258 cases of hepatectomy patients,with an infection rate of 10.85%.The main infection sites were respiratory tractand subphrenic.A total of 39 strains of pathogens were isolated,with 19 strains of gram-negative bacteria accounting for 48.72%,and 12 strains of gram-positive bacteria accounting for 30.77%,and 8 strains of fungi accounting for20.51%.The gram-positive bacteria were relatively sensitive to vancomycin and linezolid,whereas the rates of Cefalexin and cefradine resistance were higher than 50%.The resistance rates of the main gram-negative bacteria to amoxicillin,ceftriaxone,ampicillin were above 50%,whereas the strains were susceptible to imipenem and meropenem.The factors related to the postoperative infection in patients with hepatectomy included primary disease(hepatocellular carcinoma,biliary tract tumor,liver trauma),chronic disease,hospitalization time and malnutrition(P<0.05).CONCLUSION The incidence of nosocomial infections after hepatectomy is relatively high.The service management,nutritional guidance and application of antibacterial drugs after surgery should be strengthened,in order to reduce the postoperative infection rate and improve the quality of patient treatment.
OBJECTIVE To analyze the risk factors of postoperative infection in patients undergoing hepatectomy,and to explore the measures to reduce the incidence of postoperative infection after hepatectomy,so as to reduce the postoperative infection rate of patients after hepatectomy.METHODS A retrospective analysis was conducted for the clinical data of 258 cases of patients underwent hepatectomy in Affiliated Hospital of Zunyi Medical College from Jan.2011 to Dec.2016.The incidence rate of postoperative infection,composition and drug sensitivity of pathogens,as well as the preoperative physical condition and medical factors of patients were statistically analyzed.The factors related to postoperative infection in patients with hepatectomy were summarized,and the measures to reduce the postoperative infection after hepatectomy were analyzed.RESULTS 28 cases of infection occurred in 258 cases of hepatectomy patients,with an infection rate of 10.85%.The main infection sites were respiratory tractand subphrenic.A total of 39 strains of pathogens were isolated,with 19 strains of gram-negative bacteria accounting for 48.72%,and 12 strains of gram-positive bacteria accounting for 30.77%,and 8 strains of fungi accounting for20.51%.The gram-positive bacteria were relatively sensitive to vancomycin and linezolid,whereas the rates of Cefalexin and cefradine resistance were higher than 50%.The resistance rates of the main gram-negative bacteria to amoxicillin,ceftriaxone,ampicillin were above 50%,whereas the strains were susceptible to imipenem and meropenem.The factors related to the postoperative infection in patients with hepatectomy included primary disease(hepatocellular carcinoma,biliary tract tumor,liver trauma),chronic disease,hospitalization time and malnutrition(P<0.05).CONCLUSION The incidence of nosocomial infections after hepatectomy is relatively high.The service management,nutritional guidance and application of antibacterial drugs after surgery should be strengthened,in order to reduce the postoperative infection rate and improve the quality of patient treatment.
引文
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[2]冯缓,王菊梅,许瑞华,等.肝叶切除术不常规留置胃管及术后早期经口进食的安全性及可行性研究[J].护理研究,2015,24(17):2166-2168.
[3]Ding X,Carrasco-Avino G,Thung SN,et al.A two-step right hepatic lobectomy with portal vein ligation forlarge hepatocellular carcinoma:rapid induction of left-lobe regeneration and clinicopathologic correlation[J].Semin Liver Dis,2013,33(3):293-297.
[4]Ueda J,Yoshida H,Mamada Y,et al.Resection of hepatocellular carcinoma recurring in the diaphragm after right hepatic lobectomy[J].J Nippon Med Sch.2011;78(1):30-33.
[5]Luo XZ,Ming CS,Chen XP,et al.Epstein-Barr virus negative primary hepatic leiomyoma:case report and literature review[J].World J Gastroenterol,2013,19(25):4094-4098.
[6]艾源,张弢,任晓辉.我国医院感染现状与控制的进展[J].中华医院感染学杂志,2015,25(5):1198-1200.
[7]郑筱萸.中药新药临床研究指导原则[S].中国医药科技出版社,北京,2002.
[8]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,(5):314-320.
[9]冯铁诚,李新营.腹腔镜下左肝叶切除术:1例肝细胞癌合并肝硬化患者的视频报道[J].中国普通外科杂志,2015,31(1):10-11.
[10]Sacks D,Ong A,Fernandez F.Percutaneous debridement of posttraumatic infected major hepatic necrosis[J].J Vasc Interv Radiol,2014,25(8):1273-1277.
[11]刘爽峰,余益民.规则性肝段或肝叶切除术治疗复杂性肝内胆管结石的疗效临床观察[J].肝胆外科杂志,2015,23(5):384-386.