大隐静脉主干剥脱术后感染调查与预防研究

Prevalence of postoperative infections in patients undergoing great saphenous vein stripping surgery and prevention countermeasures

目的调查下肢静脉曲张行大隐静脉主干剥脱术后的感染情况,并提出相应的预防对策,以指导临床预防及合理用药。方法回顾性分析2012年3月-2015年3月收治的下肢静脉曲张行大隐静脉主干剥脱术的763例患者临床资料,调查感染发生情况,并行病原菌分布及耐药性分析,根据分析结果提出具体的预防干预措施;采用SPSS22.0软件进行统计分析。结果 763例患者中术后感染68例,感染率8.91%;双侧肢体感染45例,占66.18%;共分离82株病原菌,革兰阴性菌48株占58.54%,以铜绿假单胞菌为主,革兰阳性菌32株占39.02%,以金黄色葡萄球菌为主;主要革兰阴性菌对哌拉西林、庆大霉素、环丙沙星、妥布霉素耐药率较高,头孢类药物的耐药性也较高;主要革兰阳性菌对环丙沙星、青霉素、红霉素的耐药率较高,但对利奈唑胺、万古霉素、替考拉宁及利福平的耐药率较低。结论下肢静脉曲张行大隐静脉主干剥脱术后感染以革兰阴性菌居多,以金黄色葡萄球菌与铜绿假单胞菌为主要致病菌,且耐药较为严重;临床护理干预应结合患者的具体情况及药敏试验结果合理应用抗菌药物。

OBJECTIVE To investigate the prevalence of postoperative infections in varicose veins patients undergoing great saphenous vein stripping surgery and put forward the prevention countermeasures so as to provide guidance for clinical prevention and reasonable use of antibiotics.METHODS A total of 763 varicose veins patients who underwent the great saphenous vein stripping surgery from Mar 2012 to Mar 2015 were enrolled in the study,then the clinical data of the patients were retrospectively analyzed,the prevalence of the infections was investigated,the distribution and drug resistance of the pathogens were observed,and the specific intervention measures were put forward according to the results;the statistical analysis was performed with the use of SPSS22.0software.RESULTS Of the 763 patients,68had the postoperative infections,with the infection rate 8.91%;45patients had bilateral limb infections,accounting for 66.18%.Totally 82 strains of pathogens were isolated,including 48（58.54%）strains of gram-negative bacteria and 32（39.02%）strains of gram-positive bacteria and 32（39.02%）strains of gram-positive bacteria;the Pseudomonas aeruginosa was dominant among the gram-negative bacteria;the Staphylococcus aureus was the predominant species of the gram-positive bacteria.The main gram-negative bacteria were highly resistant to piperacillin,gentamicin,ciprofloxacin,and tobramycin as well as cephalosporins.The main gram-positive bacteria were highly resistant to ciprofloxacin,penicillin,and erythromycin,however,the drug resistance rates to linezolid,vancomycin,teicoplanin,and rifampicin were low.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative infections in the varicose veins patients undergoing great saphenous vein stripping surgery.The S.aureus and P.aeruginosaare the major species of pathogens and are highly drug-resistant.It is necessary to take the clinical nursing interventions by combining with the specific situation and reasonably use antibiotics based on the results of the drug susceptibility testing.