下肢动脉急性栓塞患者术后切口感染病原菌分布与抗菌药物应用分析

Distribution of pathogens causing postoperative incision infections in patients with acute lower extremity arterial embolism and use of antibiotics

目的探讨下肢动脉急性栓塞患者术后切口感染的病原菌分布与术后采用抗菌药物的疗效。方法选取医院2013年5月-2014年6月接诊的70例下肢动脉急性栓塞患者,将其均分为观察组和对照组,各35例,所有患者均进行急诊下肢动脉切开取栓术,分析患者术后切口感染的病原菌分布及相关因素,观察组采用头孢唑林治疗,对照组采用头孢呋辛进行治疗,比较两组患者的治疗效果。结果观察组患者术后发生感染1例,感染率为2.86%,对照组患者术后发生感染的例数为3例,感染率为8.57%;共检出病原菌13株,前3位病原菌依次为大肠埃希菌、金黄色葡萄球菌和奇异变形菌,分别占38.46%、30.77%和15.38%;切口感染的相关因素分析显示,年龄、切口长度、手术时间、抗菌药物使用天数、换药次数与切口感染的发生具有相关性(P<0.05);观察组术后治疗总有效率为91.43%、对照组为97.14%,两组比较差异无统计学意义。结论下肢动脉急性栓塞患者术后切口感染病原菌以大肠埃希菌感染为主,头孢唑林及头孢呋辛均适用于术后切口感染的预防,且两者疗效相当;完善下肢动脉急性栓塞术的术前准备、医师严格的无菌操作、对抗菌药物的合理使用是对下肢动脉急性栓塞术后切口感染预防的重要措施。

OBJECTIVE To investigate the distribution of pathogens causing the postoperative incision infections in the patients with acute lower extremity arterial embolism and observe the efficacy of postoperative use of antibiotics.METHODS A total of 70 patients with acute lower extremity arterial embolism who were treated in the hospital from May 2013 to Jun 2014 were enrolled in the study and divided into the observation group and the control group,with 35 cases in each group.All the patients underwent the emergency lower extremity arterial embolectomy.The distribution of the pathogens causing the postoperative incision infections and the related factors were observed.The observation group was treated with cefazolin,while the control group was treated with cefuroxime;the therapeutic effects were compared between the two groups.RESULTS The postoperative infection occurred in 1case in the observation group,with the infection rate of 2.86%;the postoperative infection occurred in 3cases in the control group with the infection rate of 8.57%.Totally 13 strains of pathogens were isolated;the Escherichia coli,Staphylococcus aureus,and Proteus mirabilis ranked the top three species of pathogens,accounting for38.46%,30.77%,and 15.38%,respectively.The analysis of the related factors for the incision infections indicated that the incidence of the incision infections was associated with the age,length of incision,operation duration,duration of use of antibiotics,and number of times of drug dressing（P〈0.05）.The total effective rate of the postoperative treatment of the observation group was 91.43%,the control group 97.14%,and there was no significant difference between the two groups.CONCLUSIONThe E.coli is the predominant species of pathogen causing the postoperative incision infections in the patients with acute lower extremity arterial embolism.Both cefazolin and cefuroxime are suitable for the prevention of the postoperative incision infections,and the efficacies of the two are considerably the same.It is an effective way to perfect the preoperative preparations for the lower extremity arterial embolectomy,strictly conform to the aseptic operations,and reasonably use antibiotics during the nursing so as to prevent the postoperative incision infections in the patients undergoing the emergency lower extremity arterial embolectomy.