卵巢癌患者腹腔镜术后医院感染的病原学特点及危险因素

Etiological Characteristics,Risk Factors and Preventive Measures of Nosocomial Infections in Patients with Ovarian Cancer after Laparoscopic Surgery

目的探究卵巢癌患者腹腔镜术后医院感染的病原学特点及危险因素。方法选择258例行腹腔镜术治疗的卵巢癌患者作为研究对象,分析卵巢癌患者腹腔镜术后医院感染的病原学特点、危险因素。结果258例卵巢癌患者腹腔镜术后发生医院感染共52例,占20.16%,其中以盆腔感染为主,占48.48%。52例卵巢癌患者腹腔镜术后发生医院感染者,取分泌物或血培养共发现病原菌57株,其中以革兰阴性菌为主,占75.44%,革兰阳性菌占24.56%。肺炎克雷伯菌及大肠埃希菌对头孢噻肟、头孢曲松、头孢唑林具有较强耐药性,对左氧氟沙星、美罗培南、头孢哌酮舒巴坦具有较好的药物敏感性。患者年龄≥65岁、术中出血量≥200 ml、手术时间≥2 h、术后卧床时间≥5 d、术后没有留置导管、术后使用抗菌药物<3 d、合并糖尿病、术前行化疗均是导致卵巢癌患者腹腔镜术后发生院内感染的独立危险因素(P<0.05)。结论卵巢癌患者腹腔镜术后发生医院感染的概率不容忽视,需要及时使用药物敏感性较好的抗菌药物,尽可能减少伴随的危险因素,提供相应的预防对策,以期提高患者的手术质量。

Objective To study etiological characteristics,risk factors and preventive measures of nosocomial infections in patients with ovarian cancer after laparoscopic surgery.Methods The 258 cases of ovarian cancer treated by laparoscopy were selected as the research object to explore the pathogenic characteristics,risk factors and preventive measures of the nosocomial infections of ovarian cancer patients after laparoscopy.Results There were 52 cases of nosocomial infection in 258 cases of ovarian cancer after laparoscopic surgery,accounting for 20.16%,of which pelvic infection was the main cause,accounting for 48.48%.In 52 cases of ovarian cancer,57 strains of pathogenic bacteria were found,including gram-negative bacteria,75.44%of Gram-negative bacteria,24.56%of Gram-positive bacteria.Klebsiella pneumoniae and Escherichia coli have strong resistance to cefotaxime,ceftriaxone and cefazolin,and have good drug sensitivity to levofloxacin,meropenem and cefoperazone sulbactam.The patient's age more than 65 years,the amount of bleeding in the operation more than 200 ml,the operation time more than 2 h,the bed time more than 5 day,no catheter after the operation,the use of antibiotics after the operation,the use of antibiotics 3 day,the combination of diabetes,and the preoperative chemotherapy are all the independent risk factors of the nosocomial infections in patients with ovarian cancer after laparoscopic surgery(P<0.05).Conclusion The incidence of nosocomial infection in patients with ovarian cancerafter laparoscopic surgery should not be ignored.It is necessary to use sensitive drugs,reduce the associated risk factors and provide corresponding preventive measures in order to improve the quality of the patients'operation.