妇产科腹腔镜手术患者感染的病原微生物分布与护理对策

Distribution of pathogenic microorganisms infection of patients undergoing laparoscopic surgery in the obstetrics and gynecology department and its nursing strategies

目的探讨妇产科腹腔镜手术患者围手术期感染病原微生物分布及护理措施。方法选取2015年1月至2018年6月我院妇产科收治的行腹腔镜手术患者497例作为研究对象,分离培养感染患者的病原菌,利用K-B琼脂试验检测病原菌的耐药性,采用Excel2010软件对行腹腔镜手术妇产科患者资料进行回顾性分析。结果497例行腹腔镜根治术患者中感染54例,感染率10.87%;术后感染诊断时间2~10d,平均6.8d;感染部位以切口感染为主,占57.41%;其次为盆腔感染,占33.33%。病原菌标本来源:手术创口分泌物21例(38.89%),尿液16例(29.63%),引流液14例(25.92%),深部痰液3例(5.56%)。主要病原微生物是G-菌34株(62.96%),G+菌20株(37.04%)。G-菌中大肠埃希菌18株(33.33%),肺炎克雷伯菌7株(12.96%),铜绿假单胞菌6株(11.11%),鲍曼不动杆菌2株(3.70%),其他1株(1.85%);G+菌中金黄色葡萄球菌11株(20.37%),粪肠球菌7株(12.96%),表皮葡萄球菌2株(3.70%)。大肠埃希菌对亚胺培南、左旋氧氟沙星敏感,金黄色葡萄球菌对万古霉素敏感,粪肠球菌对万古霉素、亚胺培南敏感。结论正确认识妇产科腹腔镜手术感染的病原菌分布,严格按无菌操作,制定精细化个性化护理流程,可降低术后感染率,保证手术效果,提高患者满意度。

Objective To explore the distribution of pathogenic microorganisms in peri-operative infection of patients undergoing laparoscopic surgery in the obstetrics and gynecology department and its nursing measures.Methods To select 497 cases of patients who underwent laparoscopic surgery in the obstetrics and gynecology department of our hospital from January 2015 to June 2018 as the study subjects.The pathogens of infected patients were isolated and cultured.We used the K-B agar test to detect the drug resistance of pathogens.In addition,we used Excel 2010 software to conduct retrospective analysis of data of these patients undergoing laparoscopic surgery in the obstetrics and gynecology department.Results Among the 497 patients who underwent laparoscopic radical surgery,a total of 54 patients had infection,with the infection rate of 10.87%.The postoperative infection diagnosis time was between 2 days to 10 days,with an average of 6.8 d.Regarding the infected site,it was mainly incision infection,accounting for 57.41%.The second was pelvic infection,accounting for 33.33%.Sources of pathogens were as follows:21 cases(38.89%)of surgical wound secretion,16 cases(29.63%)of urine,14 cases(25.92%)of drainage fluid,and 3 cases(5.56%)of deep sputum.The main pathogenic microorganisms were 34 strains(62.96%)of Gram-negative and 20 strains(37.04%)of Gram+positive.Among the Gram-negative,there were 18 strains(33.33%)of escherichia coli,7 strains(12.96%)of klebsiella pneumoniae,6 strains(11.11%)of Pseudomonas aeruginosa,2 strains(3.70%)of acinetobacter baumannii,and 1 strain(1.85%)of other strains.Among the Gram+positive,there were 11 strains(20.37%)of staphylococcus aureus,7 strains(12.96%)of enterococcus faecalis,and 2 strains(3.70%)of stagphylococcus epidermidis.The escherichia coli was sensitive to imipenem and levofloxacin.The staphylococcus aureus was sensitive to vancomycin,and the enterococcus faecalis was sensitive to vancomycin and imipenem.Conclusion We should establish correct understanding of the distribution of pathogenic bacteria in laparoscopic surgery of obstetrics and gynecology department,and develop refined personalized nursing procedures strictly according to aseptic operation.So,we can reduce the postoperative infection rate,and ensure the surgical effect,thus improving patient satisfaction.