心瓣膜置换术后感染预防的临床研究

Clinical research on prevention of postoperative infection in patients with heart valve replacement

目的 探讨心瓣膜置换术后感染预防的临床研究.方法 选取2013年8月至2015年8月近2年来于本院进行心瓣膜置换术的84例患者,随机分为对照组和观察组.对照组患者采取心瓣膜置换术常规干预措施,而观察组患者在对照组基础上给予综合干预措施.观察比较两组患者主动脉阻断时间、机械通气时间、麻醉清醒时间、ICU停留时间、饮食恢复时间及住院时间等手术各指标时间;分别于诱导前、转流1h、停机1h及停机24 h采取两组患者静脉血,检测两组患者血浆中TNF-α、IL-6及IL-10等含量变化;分别于诱导前、手术后1d及术后5d检测两组患者血清中CK-MB与cTnI含量变化;记录两组患者术后感染发生情况,并统计分析与比较.结果 ①观察组患者机械通气时间、麻醉清醒时间、ICU停留时间、饮食恢复时间及住院时间等手术各指标时间均显著短于对照组患者（P＜0.05）.②两组患者麻醉后血浆各指标含量显著上升,停机1h达到高峰,停机24 h逐渐下降但仍高于诱导前血浆各指标含量;麻醉后,与对照组相比较,观察组血浆中TNF-α和IL-6含量显著降低,IL-I0含量显著升高,差异均有统计学意义（P＜0.05）.③较诱导前,两组患者术后血清中CK-MB与cTnI含量均显著上升,且观察组术后血清中CK-MB与cTnI含量均低于对照组患者,差异均有统计学意义（P＜0.05）.④观察组患者术后感染率（2.3％）显著低于对照组（7.3％）,两组比较差异均有统计学意义（P＜0.05）.结论 综合干预措施可显著降低心瓣膜置换患者术后的感染发生情况,促使患者快速康复,临床效果显著.

Objective To study the prevention of postoperative infection in patients with heart valve replacement.Methods 84 patients with heart valve replacement in our hospital during August 2013 and August 2015 were selected and randomly divided into control group and observation group.Patients of control group received conventional intervention measures of heart valve replacement,and patients of observation group received comprehensive intervention measures on the basis of control group.Compared aortic block time,mechanical ventilation time,anesthesia awake time,ICU stay time,diet recovery time,and hospital stay between two groups;tested TNF-α,IL-6,and IL-10 of two groups,tested CK-MB and cTnI of two groups before induction,1,5 d after operation;recorded and compared the incidence of postoperative infection.Results ① Mechanical ventilation time,anesthesia awake time,ICU stay time,diet recovery time,and hospital stay of observation group were all significantly shorter than those of control group （P〈0.05）.② After anesthesia,the serum content of every index of two groups considerably increased,the peak occurred at downtime 1 h,gradually declined within downtime 24 h,but still higher than those before induction;after anesthesia,compared with control group,plasma TNF-α,IL-6 levels of observation group significantly decreased,IL-10 level significantly increased,with statistically significant differences （P〈0.05）.③ Postoperative CK-MB and cTnI levels in two groups significantly increased compared before induction,and postoperative CK-MB and cTnI levels in observation group were lower than those in control group,with statistically significant differences （P〈0.05）.④ The incidence of postoperative infection in observation group was 2.3%,which was significantly lower than that in control group （7.3%）,with statistically significant difference （P〈0.05）.Conclusion Comprehensive intervention can significantly reduce postoperative infection in patients with heart valve replacement and prompt rapid rehabilitation.