下肢动脉旁路术后人工血管感染的预防

Prevention and treatment of infection after lower extremity arterial bypass

目的探讨下肢动脉旁路术后人工血管感染的处理方法,为预防和治疗患者感染提供参考依据。方法选取2004年5月-2013年5月在医院接受治疗的下肢动脉旁路术后人工血管感染患者9例;对所有患者进行病原菌培养及药敏试验,根据结果选择抗菌药物,出院后对患者进行定期随访,记录随访结果。结果 9例感染患者术后保肢6例、截肢2例、围手术期死亡1例,死亡原因为并发心肌梗死;8例术后生存患者均进行12-60个月随访,其中1例患者在随访中死亡,死亡原因为脑出血;生存7例,其中3例保留通畅血管,2例去除人工血管未重建血运,2例截肢患者无异常;下肢动脉旁路术后人工血管感染病死率为22.22%、存活率为77.78%、截肢率为22.22%。结论下肢动脉旁路术后人工血管感染病死率和截肢率较高,临床上一旦发生,大多需要取出人工血管,对于血运通畅者可考虑保留人工血管。

OBJECTIVE To investigate the treatment methods for infection after lower extremity arterial bypass ,so as to provide reference for better prevention and treatment of patient infection .METHODS Totally 9 patients who had artificial blood vessel infection after lower extremity arterial bypass during May 2004 to May 2013 in the hos‐pital were enrolled .Pathogen culture and antimicrobial susceptibility test were conducted for all the patients and the appropriate antimicrobial drugs were selected according to the test results .Regular follow‐ups were conducted after discharge ,and the follow‐up results were recorded .RESULTS Among the nine patients ,there were six cases of limb salvage ,two cases of amputation ,one case of perioperative death due to concurrence of myocardial infarc‐tion .The eight cases of survival patients were followed up for 12~60 months and one patient died during follow‐up due to cerebral hemorrhage .The other seven patients survived ,including three cases of retained patency of blood vessels ,two cases of removing artificial blood vessel without revascularization and two cases of amputation with no abnormalities .The mortality rate was 22 .22% for lower extremity arterial bypass ,the survival rate was 77 .78% ,the amputation rate was 22 .22% .CONCLUSION Artificial blood vessel infection after lower extremity arterial bypass has high amputation and mortality rate .Once happens ,most cases need to remove the artificial blood vessel ,and revascularization may be considered for unobstructed artificial blood vessels .