老年瓣膜病患者心瓣膜置换术后感染预防的临床研究

Clinical study on prevention of postoperative infections in elderly patients with valvular disease undergoing heart valve replacement

目的探讨老年瓣膜病患者实施心瓣膜置换术后感染预防的方法,以降低术后感染率。方法选取2011年1月-2012年4月医院收治的行心瓣膜置换术老年瓣膜病患者112例,将其随机分为对照组55例和观察组57例,对照组围术期采用常规措施进行术后感染预防,观察组围术期采用综合干预措施预防术后感染,比较两组患者术后感染率。结果两组患者主动脉阻断时间差异无统计学意义;观察组患者机械通气、麻醉清醒、ICU停留、饮食恢复及住院时间均明显短于对照组;两组患者在手术开始后肿瘤坏死因子(TNF-α)、白介素-6(IL-6)以及白介素-10(IL-10)血浆含量均明显升高,至停机1h达高峰,停机24h下降,但仍高于麻醉诱导前;观察组患者TNF-α、IL-6上述时刻血浆含量明显高于对照组,IL-10明显低于对照组;两组患者于术后1d和5d时肌酸激酶同工酶(CK-MB)以及cTnT水平均明显高于麻醉诱导前,且对照组患者明显高于观察组;观察组患者术后共有1例发生术后感染,感染率为1.75%,对照组患者术后共有4例发生感染,感染率为7.27%,两组比较差异有统计学意义(P<0.05)。结论老年患者行心瓣膜置换术后机体受到的损伤较大,恢复也较慢,易发生术后感染,因此在围手术期给予患者综合干预措施,可以降低患者术后感染率,提升患者恢复效率,提高手术治疗质量。

OBJECTIVE To explore the prevention measures for postoperative infections in elderly patients with val-vular disease undergoing heart valve replacement so as to reduce the incidence of postoperative infections. METHODS A total of 112 elderly patients with valvular disease who underwent heart valve replacement from Jan 2011 to Apr 2012 were enrolled in the study and randomly divided into the control group with 55 cases and the ob-servation group with 5 7 cases;the control group was treated the conventional perioperative prevention measures for postoperative infections,while the observation group was treated with the comprehensive perioperative inter-vention measures for postoperative infections,and the incidence of postoperative infections was observed and com-pared between the two groups.RESULTS There was no statistically significant different in the aortic clamping time between the two groups.The mechanical ventilation duration,time of awake from anesthesia,length of ICU stay, time of recovery of diet,and length of hospital stay of the observation group were significantly shorter than those of the control group.The contents of the tumor necrosis factor （TNF-α）,interleukin-6 （IL-6）,and interleukin-10 （IL-10）in plasma of both groups were remarkably elevated after the surgery started,reaching to the peak at 1 hour of shutdown,declining at 24 hours of shutdown,but they were still higher than those before the induction of anesthesia.The contents of the plasma TNF-αand IL-6 at the above time points were significantly higher in the ob-servation group than in the control group,while the content of the plasma IL-10 of the observation group was sig-nificantly lower than that of the control group.The levels of the creatine kinase MB isoenzyme （CK-MB）and cTnT＆amp;nbsp;of both groups were significantly higher at 1 day or 5 days after the surgery than before the induction of anesthesia and were significantly higher in the control group than in the observation group.The postoperative infections oc-curred in 1 case in the observation group with the infection rate of 1.75% and in 4 cases in the control group with the infection rate of 7.27%,there was statistically significant difference between the two groups （P〈0.05）. CONCLUSION The elderly patients undergoing the heart valve replacement suffer from great body damage,recover more slowly,and tend to have the postoperative infections,therefore,it is necessary to take the comprehensive in-tervention measures during the perioperative period so as to reduce the incidence of postoperative infections,raise the efficiency of recovery,and improve the quality of surgical treatment.