围术期高浓度吸氧与腹部手术患者术后切口感染的相关性分析

Relationship between perioperative inhalation of high concentration oxygen and postoperative incision infection in patients undergoing abdominal surgery

目的探讨术中及术后短时间高浓度吸氧对腹部Ⅱ类手术切口感染的影响,为临床治疗提供参考。方法选择2014年1月-2017年1月医院收治的腹部Ⅱ类手术患者496例,随机数字表法分为两组,对照组248例,手术开始直至术终,均采用鼻导管吸氧,氧浓度(FiO_2)为28%,试验组248例,手术开始直至术后2h内采用防漏面罩吸氧,FiO_2为60%,比较两组手术效果及术后切口感染率,分析腹部手术切口感染的病原菌分布及耐药性。结果试验组PaO_2水平高于对照组(P<0.05);试验组手术时间短于对照组(P<0.05);试验组切口感染率低于对照组(P<0.05);60例感染患者共培养出病原菌76株,其中革兰阴性菌40株占52.63%,革兰阳性菌32株占42.11%,真菌4株占5.26%;铜绿假单胞菌对头孢他啶、头孢吡肟、亚胺培南和美罗培南敏感性较高,耐药率为16.67%;鲍氏不动杆菌对临床常用的抗菌药物均表现出高度耐药性;金黄色葡萄球菌和表皮葡萄球菌对青霉素G和克拉霉素均表现出高度的耐药性,而对替加环素、利奈唑胺和万古霉素均敏感,耐药率为0。结论腹部Ⅱ类手术患者开展术中及术后短时间高浓度吸氧可降低术后切口感染率,应针对病原菌耐药性合理应用抗菌药物。

OBJECTIVE To explore the influence of short time of intraoperative and postoperative inhalation of high concentration oxygen on surgical incision infections in patients undergoing type II abdominal surgery so as to pro-vide guidance for clinical treatment.METHODS A total of 496 patients who underwent the abdominal type II sur-gery in hospitals from Jan 2014 to Jan 2017 were enrolled in the study and randomly divided into the control group with 248 cases and the observation group with 248 cases.The control group was treated with oxygen inhalation by using nasal catheter from the start to the end of surgery,with the oxygen concentration（FiO2）28%,while the observation group was treated with oxygen inhalation by using leak-proof mask from the start to the time point of within 2 hours after the surgery,with the FiO2 60%.The surgical effect and incidence of postoperative incision infections were compared between the two groups,and the distribution and drug resistance of the pathogens cau-sing the surgical incision infections were observed.RESULTS The PaO2level of the observation group was signifi-cantly higher than that of the control group（P〈0.05）;the operation duration of the observation group was sig-nificantly shorter than that of the control group（P〈0.05）.Totally 76 strains of pathogens were isolated form the 60 patients with the infection,of which 40（52.63%）were gram-negative bacteria,32（42.11%）were gram-posi-tive bacteria,and 4（5.26%）were fungi.The drug resistance rates of Pseudomonas aeruginosa strains to ceftazi-dime,cefepime,imipenem and meropenem were 16.67%.Acinetobacter baumannii strains were highly resistant to the commonly used antibiotics;the Staphylococcus aureus and Staphylococcus epidermidis strains were highly re-sistant to penicillin G and clarithromycin,however,the drug resistance rates to tigecycline,linezolid and vancomycin were 0%.CONCLUSION The short time of intraoperatie and postoperative inhalation of high concen-tration oxygen may reduce the incidence of postoperative incision infections in the patients undergoing the abdomi-nal type II surgery.It is necessary to reasonably use antibiotics based on the drug resistance of the pathogens.