心胸外科手术后肺部感染的病原菌分布特点及护理干预

Distribution of pathogens and nursing intervention among patients with post-cardiothoracic surgery pulmonary infection

目的分析心胸外科手术后肺部感染的病原菌分布特点,探讨加强抗感染的护理干预措施对患者术后呼吸功能的改善情况。方法回顾性分析绍兴市立医院进行心胸外科手术治疗的468例患者的临床资料,统计术后肺部感染的发生率及病原菌的分布类型。从中随机抽取120例患者,根据护理干预方式的不同分为对照组62例和干预组58例,对照组患者只给予基础护理,干预组患者则加强抗感染的护理干预。对比两组患者术后呼吸功能的改善情况及肺部感染的发生率。结果 468例患者术后共发生肺部感染42例(8.97%),共培养出病原菌42株。铜绿假单胞菌所占的比例最高(30.95%),白色假丝酵母菌所占的比例最低(2.38%);干预组患者术后动脉氧分压[(98.27±24.57)mmHg]、呼吸频率[(16.19±4.05)次/min]、最大通气量[(71.37±17.84)L]、时间通气量[(2.95±0.74)L/h]及第1秒用力呼气容积[(1.37±0.35)L]明显好于对照组[(89.36±22.34)mmHg,(13.26±3.32)次/min,(52.18±13.05)L,(2.43±0.61)L/h,(1.09±0.28)L];干预组术后肺部感染发生率(2.00%)、肺不张发生率(2.00%)明显少于对照组(12.00%,10.00%),差异均具有统计学意义(P<0.05)。结论心胸外科手术后肺部感染以革兰阴性菌为主,根据病原菌分布特点及药敏试验给予合理的抗菌药物治疗并加强抗感染的护理干预,能明显改善患者术后的呼吸功能,降低肺部感染率的发生,提高预后效果。

Objective To analyze the characteristics of the distribution of pathogenic bacteria of pulmonary infection after cardiothoracic surgery,amd discuss the effect of nursing intervention on the improvement of patients＇ respiratory function.Methods A retrospective analysis was performed on the clinical data of 468 patients who accepted cardiothoracic surgery in our hospital with regard to the incidence rate of postoperative pulmonary infection and the distribution of pathogens,among whom 120 patients were randomly selected and divided into the control group（62cases）or intervention group（58cases）according to the ways of nursing intervention.The control group was given basic nursing care,while the intervention group was given intensive anti-infection nursing intervention.The incidence rate of postoperative pulmonary infection and improvement of respiratory function were compared between the two groups.Results A total of 42 cases of pulmonary infection（8.97%）were found among the 468 patients,and 42 strains of pathogens were isolated.The detection rate of Pseudomonas aeruginosa was the highest（30.95%）,while that of Candida albicans lowest（2.38%）.The arterial partial pressure of oxygen [（98.27±24.57）mmHg],respiratory frequency[（16.19±4.05）/min],maximal ventilatory volume[（71.37±17.84）L],minute ventilation[（2.95±0.74）L/h]and the forced expiratory volume in 1s[（1.37±0.35）L]of the patients in the intervention group were obviously superior to those in the control group [（89.36±22.34）mmHg,（13.26±3.32）/min,（52.18±13.05）L,（2.43±0.61）L/h,（1.09±0.28）L].The incidences of postoperative pulmonary infection（2.00%）and pulmonary atelectasis（2.00%）were significantly lower than those in the control group（12.00%,10.00%）（P〈0.05）.Conclusion Gram negative bacteria are the main pathogens causing pulmonary infection after cardiothoracic surgery.Treatment with antimicrobial agents based on drug sensitivity test and proper nursing intervention against the infection can significantly improve the patients＇ respiratory function,reduce the incidence of pulmonary infection,and improve prognosis.