外科重症患者术后并发呼吸道感染的临床分析

Clinical analysis of surgical intensive patients complicated with respiratory tract infections

目的分析外科重症患者并发呼吸道感染的临床特点,探讨干预措施,为临床防治提供参考。方法选取医院收治的420例外科重症患者为研究对象,根据是否并发呼吸道感染分为呼吸道感染组94例和未并发呼吸道感染组326例,回顾性分析所有患者术后呼吸道感染的病原菌、药物敏感性以及相关危险因素等。结果外科重症患者并发术后呼吸道感染发生率为22.38%;主要病原菌为金黄色葡萄球菌、大肠埃希菌和铜绿假单胞菌,分别为34、31、24株;金黄色葡萄球菌对万古霉素的敏感性最高,敏感率为100.00%;大肠埃希菌对亚胺培南的敏感性最高,敏感率为96.77%;铜绿假单胞菌对阿米卡星的敏感性最高,敏感率为79.16%;呼吸道感染组患者既往吸烟史、慢性呼吸道疾病史及术前低蛋白血症患者分别占42.55%、53.19%和23.40%,均高于未并发呼吸道感染组的12.88%、11.04%和11.04%,差异有统计学意义(P<0.05);呼吸道感染组术后使用镇痛泵患者占21.28%,低于未并发呼吸道感染组的47.85%,差异有统计学意义(P<0.05);呼吸道感染组患者术前住院、术中气管插管、术后留置鼻胃管及术后呼吸机使用时间均大于非并发呼吸道感染组,差异有统计学意义(P<0.05)。结论针对诸多相关危险因素采取相应防治措施有利于减少术后感染的发生。

OBJECTIVE To analyze the clinical characteristics of the surgical intensive patients complicated with respiratory tract inferctions and put forward the intervention measures so as to guide the clinical treatment.METHODS A total of 420cases of surgical intensive patients were selected as the observation objects and were divided into the respiratory tract infection group with 94cases and the non-respiratory tract infections with 326 cases,then the species of pathogens causing postoperative respiratory tract infections,drug susceptibility,and the related risk factors were retrospectively analyzed.RESULTS The incidence rate of postoperative respiratory tract infections in the surgical intensive patients was 22.38%.The main pathogenic bacteria were Staphylococcus aureus,Escherichia coli,and Pseudomonas aeruginosa,the number of the strains were respectively 34strains,31 strains,and 24strains.The drug susceptibility rate of S.aureus to vancomycin was the highest（100.0%）;the drug susceptibility rate of E.coli to imipenem was the highest（96.77%）;the drug susceptibility rate of P.aeruginosa to amikacin was the highest（79.16%）.Of the patients with concurrent respiratory tract infections,the patients with smoking history accounted for 42.55%,the patients with chronic respiratory diseases 53.19%,the patients with preoperative hypoalbuminemia,significantly higher than 12.88%,11.04%,and 11.04% of the patients without concurrent respiratory tract infections,the difference was statistically significant（P〈0.05）;The percentage of patients with postoperative analgesia pump in the respiratory tract infection group was 21.28%,47.85% in the non-respiratory tract infection group,the difference was statistically significant（P〈0.05）;the preoperative hospitalization duration,the intraoperative endotracheal intubation time,the postoperative indwelling nasogastric tube time,and the time of postoperative use of ventilator of the respiratory tract infection group were significantly more than those of the non-respiratory tract infection group,the difference was statistically significant（P 0.05）.CONCLUSION To take corresponding prevention and control measures according to the related risk factors can contribute to the reduction of the postoperative infections.