心脏术后患者发生纵膈感染的相关因素分析

Related factors for mediastinal infections in patients after cardiac surgery

目的探讨心脏外科术后患者发生纵隔感染的相关因素,为防治感染提供临床依据。方法选取2012年1月-2016年12月期间医院接受心脏外科手术患者233例作为研究对象,对患者术后发生纵膈感染情况及相关因素进行统计分析,并分析纵膈感染患者病原菌分布特点。结果 233例心脏外科术后患者有11例发生纵膈感染,感染率为4.72%;多因素Logistic回归分析显示,高龄、糖尿病、高血脂症、开放式换药、血运障碍与纵膈感染呈正相关性,是纵膈感染的影响因素;11例感染患者共分离出病原菌18株,其中革兰阴性菌8株,占44.44%,以铜绿假单胞菌为主,革兰阳性菌10株,占55.56%,以肠球菌为主。结论心脏外科手术患者术后发生纵膈感染情况较严重,发生感染的相关因素较多,针对相关因素进行早诊断、早治疗,以降低术后纵膈感染的发生率。

OBJECTIVE To explore the related factors for mediastinal infections in patients after cardiac surgery so as to provide guidance for prevention and treatment of infections.METHODS A total of 233 patients who received cardiac surgery in the hospital from Jan 2012 to Dec 2016 were recruited as the study objects, the prevalence of postoperative mediastinal infections was investigated, the related factors for the infections were statistically ana- lyzed, and the distribution of pathogens isolated from the patients with mediastinal infections was observed. RESULTS Of the 233 patients who received the cardiac surgery, 11 had postoperative mediastinal infections, with the infections rate 4.72%.The multivariate logistic regression analysis indicated that the incidence of mediastinal infections was positively correlated with the advanced age, diabetes mellitus, hyperlipidemia, open drug dressing and blood circulation disorder, which were the influencing factors for the mediastinal infections.Totally 18 strains of pathogens were isolated from the 11 patient with infections, of which 8 （44.44%） were gram-negative bacteria, and 10 （55.56 %） were gram-positive bacteria~ Pseudomonas aeruginosa was the predominant species of the gram- negative bacteria; Enterococcus was dominant among the gram-positive bacteria.CONCLUSION The prevalence of the postoperative mediastinal infections is high among the patients undergoing the cardiac surgery, there are a va- riety of related factors for the infections.It is necessary to carry out the early diagnosis and treatment according to the related factors so as to reduce the incidence of postoperative mediastinal infections.