早期喉癌患者术后医院感染状况与干预措施研究

Prevalence of postoperative nosocomial infections in patients with early laryngeal cancer and intervention measures

目的研究早期喉癌患者术后医院感染的状况,并提出相关的干预措施。方法回顾性分析2012年1月-2016年12月医院收治的81例早期喉癌患者的病例资料,研究早期喉癌患者术后医院感染部位及病原菌分布情况,分析引起早期喉癌患者术后医院感染的影响因素。结果 81例早期喉癌患者术后发生医院感染15例,感染率为18.52%;感染部位主要为肺部、手术切口及咽部,分别占40.00%、26.67%及19.99%;患者病灶分泌物进行细菌培养后共分离出病原菌21株,其中革兰阳性菌8株占38.09%,革兰阴性菌12株占57.14%;年龄≥60岁、吸烟史、术中出血量≥20ml、术前血清白蛋白≤2.5g/L、糖尿病史、临床分期为Ⅱ期以及手术时间>4h均是导致喉癌术后医院感染的相关因素(P<0.05);吸烟史、术中出血量≥20ml、术前血清白蛋白≤2.5g/L、糖尿病史、临床分期为Ⅱ期以及手术时间>4h是引起早期喉癌患者术后医院感染的影响因素(P<0.05)。结论早期喉癌患者术后医院感染多为肺部感染,病原菌以革兰阴性菌为主,术前患者停止吸烟、改善营养状况、控制血糖,术中控制出血量、避免长时间手术,对术后医院感染均有积极的预防作用。

OBJECTIVE To investigate the prevalence of postoperative nosocomial infections in patients with early laryngeal cancer and put forward the related intervention measures.METHODS The medical data of 81 patients with early laryngeal cancer who were treated in the hospital from Jan 2012 to Dec 2016 were retrospectively analyzed,the infection sites of the patients with postoperative nosocomial infections and distribution of pathogens were observed,and the influencing factors for the postoperative nosocomial infection in the patients with early laryngeal cancer were analyzed.RESULTS Of the 81 patients with early laryngeal cancer,15 had postoperative nosocomial infections,with the infection rate 18.52%,40.00% of whom had pulmonary infections,26.67% had surgical incision infection,and 19.99% had pharyngeal infections.A total of 21 strain of pathogens were isolated from focal secretions through bacterial culture,8（38.09%）of which were gram-positive bacteria,and 12（57.14%）were gram-negative bacteria.The related factors for the postoperative nosocomial infection in the patients with laryngeal cancer included the no less than 60 years of age,smoking history,no less than 20 ml of intraoperative bleeding,level of preoperative albumin no more than 2.5 g/L,history of diabetes mellitus,clinical stage Ⅱ and operation duration more than 4 hours（P〈0.05）.The smoking history,no less than 20 ml of intraoperative bleeding,level of preoperative albumin no more than 2.5 g/L,history of diabetes mellitus,clinical stageⅡ and operation duration more than 4 hours were the influencing factors for the postoperative nosocomial infections in the patients with early laryngeal cancer（P〈0.05）.CONCLUSION The patients with pulmonary infections are dominant among the early laryngeal cancer patients with postoperative nosocomial infections,the gram-negative bacteria are the predominant pathogens.It is an effective way to quit smoking before surgery,improve nutritional status,control blood glucose and intraoperative bleeding volume and shorten the operation duration so as to prevent the postoperative nosocomial infections.