胃肠肿瘤外科手术切口感染调查和防治对策

Surgical Incision Infection of Gastrointestinal Carcinoma:Investigation and Prevention Measures

目的对胃肠肿瘤外科手术切口感染进行调查,为制定科学的防治对策提供依据。方法对2005年1月-2009年12月行胃肠肿瘤外科手术1290例患者的切口感染进行回顾性调查和统计分析,以中华人民共和国卫生部《医院感染诊断标准》为诊断依据。结果发现手术切口感染83例次,感染率6.4%;手术切口感染病原菌监测发现革兰阴性杆菌62株,占74.7%,革兰阳性球菌12株,占14.5%,真菌9株,占10.8%;细菌对万古霉素的敏感性达100.0%,真菌对酮康唑、氟康唑、两性霉素B、制霉菌素敏感率均为100.0%;Logistic回归分析显示,年龄、腹部手术史、合并糖尿病、肿瘤类型、术后白蛋白水平、手术类型、切口类型、切口长度、手术时间、住院时间为切口感染的危险因素(均P<0.05)。结论切口感染是胃肠肿瘤外科手术患者较为常见的并发症之一,应采取措施控制危险因素,根据药敏结果合理使用抗菌药物,可减少切口感染的发生,促进患者的康复。

OBJECTIVE To investigate the incidence of surgical incision infection of gastrointestinal carcinoma, and provide evidence for prevention measures. METHODS Totally 1290 patients from Jan 2005 to Dec 2009 in our hospital were investigated retrospectively. The diagnosis standard was based on the Diagnosis Standard of Hospital Infection published by state Ministry of Health in Jan 2001. RESULTS Of 1290 cases after surgical operation 83 cases suffered incision infection, the infection rate was 6.4%. The pathogenic bacteria of incision infection were confirmed as G- bacilli （62 strains, 74.7%）, G＋ cocci （12 strains, 14.5%）, and fungi（9 strains, 10.8%）. The sensitivity of bacteria to vancomyein was 100. 0%, the sensitivity of fungi to ketoconazole, fluconazole, amphotericin 13 and nystatin were and 100.0%. The Logistic regression analysis showed that, age, the abdominal operation history, complicated with diabetes mellitus, type of carcinoma, the level of serum albumin after operation, operation type, incision type, incision length, duration of operation, and hospitalization time were the risk factors for incision infection（P〈0.05）. CONCLUSIONS The surgical incision infection is a commonly encountered complication in the patients of gastrointestinal carcimoma. Measures must be done to control the risk factors and use reasonably antibiotics based on drug sensitivity, after that it may be helpful to reduce the incidence of incision infection and promote the rehabilitation of patients.