肛门及肛管手术后院内感染的病原学分析及免疫功能变化

Analysis of the anus and anal canal etiology of postoperative nosocomial infection and immune function changes

目的探讨肛门及肛管手术后院内感染的病原学分析及免疫功能变化。方法选取需行肛门及肛管手术的患者130例为研究对象,对其临床资料进行分析,观察其手术后院内感染情况,包括感染类型分布、病原学分析及免疫功能变化。结果共有67例院内感染发生,感染率为51.5%(67/130),感染类型主要为会阴伤口感染、腹部感染和盆腔感染,尿道和阴道感染人数较少。共收集病原菌93株,其中革兰阴性杆菌占67.7%(63/93),包括脆弱类杆菌(21.5%)、大肠埃希菌(18.3%)、铜绿假单胞菌(10.8%);革兰阳性菌占23.7%(30/93),包括金黄色葡萄球菌(17.2%)、表皮葡萄球菌(6.5%)、真菌类5株,占5.4%、其他菌株(3.2%)。患者院内感染前后除IgM水平比较差异无统计学意义(P>0.05)外,其余免疫指标比较差异均有统计学意义(P<0.05)。结论肛门及肛管手术患者院内感染发生率较高,严重影响患者的治疗效果,临床上应对此采取预防和控制措施。

Objective To investigate the etiology of the nosocomial infection and immune function changes anus and anal after operation.Methods 130 patients who needed anus and anal canal surgery were recruited in the study.The clinical data were recorded and postoperative nosocomial infection data were observed,including infection type,distribution,pathogenic analysis and immune function.Results A total of 67 cases of nosocomial infection occured,the infection rate was 51.5%（67/130）,the main types of infection were perineal wound infection,abdominal infections and pelvic infections,urinary tract and vaginal infections were rare.93 isolates were collected,of which gram-negative bacilli accounted for 67.7%（63/93）,including bacteroides fragilis（21.5%）,Escherichia coli（18.3%）,Pseudomonas aeruginosa（10.8%）;Gram-positive bacteria accounted for 23.7%（30/93）,including Staphylococcus aureus（17.2%）,Staphylococcus epidermidis（6.5%）;5fungi were isolated accounting for 5.4%,other strains accounted for 3.2%.All the immune parameters detected in patients with postoperative nosocomial infection were statistically different from those before infection（P〈0.05）except for IgM（P〉0.05）.Conclusion The incidence of nosocomial infection was relatively high in patients who had anus and anal canal surgery,which could serious affect the patients’ outcomes,preventive and control measures should be taken in clinical practice.