口腔颌面外科术后感染的临床观察

Clinical observation of postoperative oral and maxillofacial surgery infection

目的：探究和分析口腔颌面部外科手术后感染的相关因素及治疗效果。方法：从2015年6月-2017年3月期间本院收治的所有行口腔颌面部外科手术中选取其中的240例患者作为本次的研究对象，并对这240例患者的术后发生感染及其相关因素进行分析，将48例术后感染患者随机分为对照组和观察组，对照组给予单用广谱抗菌药物治疗，观察组给予广谱抗菌药物联合用药，对比两组患者的治疗效果。结果：在本次选取的240例行口腔颌面外科术的患者中，发生术后感染的有48例，术后感染率为20%，在这48例患者当中，主要以良性肿瘤和恶性肿瘤术后感染为主。在这48例术后感染患者中，一共分离出68株病原菌，这68株病原菌中，革兰阳性菌有43株，其中以葡萄球菌属为主；革兰阴性菌有17株，以铜绿假单胞菌为主；这部分革兰阳性菌和革兰阴性菌中厌氧或兼性厌氧菌为30株（占44．12％）；真菌有8株。导致患者术后发生感染的主要因素有年龄、手术操作不规范以及误吸。从治疗效果来看，观察组患者的临床治疗效果显著优于对照组，差异有统计学意义（P〈0．05）。结论：口腔颌面外科术后感染主要的病原菌为菌葡萄球菌属铜绿假单胞菌。导致口腔颌面术后发生感染的主要原因与患者的年龄、手术操作不规范以及患者误吸有关；采用多种广谱抗菌药物联合用药的方法能够有效提高患者术后感染的治疗效果。

Objective： To explore and analyze the factors and the therapeutic effect relating to the infection after oral and maxillofacial surgery. Methods： From AprilJune 2015 to March 2017, 240 patients who underwent oral and maxillofacial surgery in our hospital were analyze＆ 48 cases ofpostoperative infection were divided into control group and observation group randomly. The control group was given a wide-single spectrum ofantimicrobial drugs alone, while the observation group were given a wide-spectrum range of antimicrobial drugs in combination. Therapeutic effects were compared between the two groups. Results： Among the 240 patients who underwent oral and maxillofacial surgery, postoperati＇ce infection occurred in 48 cases. The infection rate was 20%. Most of the cases underwent surgery were because of benign or malignant tumors. 68 pathogenic bacteria were isolated from the patients. 43 strains of them were gram-positive and mainly composed of staphylococcus species. 17 strains were gram-negative bacteria and most of them were pseudomonas aeruginosa. 30 strains of them were anaerobic or facultative anaerobic bacteria （44.12%） . 8 strains of fungi were isolated. The main factors that led to postoperative infection were related with age, irregular operation and respiratory aspiration. From the treatment effect, the clinical effect of the observation group was significantly better than the control group, and the difference was statistically significant （P〈0.05） . Conclusion： Pathogen analysis of postoperative infection showed can be seen, the main pathogen were is Staphylococcus aureus and Pseudomonas aemginosa. The main causes of oral and maxillofacial infection were related with the patient＇s age, irregular operation and patient aspiration. The use of a variety of broad-spectrum antimicrobial drugs can effectively improve the outcome of patients with postoperative infection.