乳腺癌改良根治术的患者围手术期感染及相关危险因素的回顾性分析

Retrospective Analysis of Perioperative Infection and Related Risk Factors in Patients with Modified Radical Mastectomy

目的探讨乳腺癌改良根治术患者围手术期的感染情况及相关危险因素。方法回顾性选取120例乳腺癌改良根治术的患者作为研究对象。收集患者围手术期相关临床资料,分析引起患者在围手术期手术切口及引流管感染的相关危险因素。结果120例患者共发生20例切口及引流管感染,感染率为16.67%。将20例切口及引流管感染的局部分泌物进行培养,总共检出27株病原菌,其中革兰阳性菌19株(70.37%),革兰阴性菌8株(29.63%)。金黄色葡萄球菌、表皮葡萄球菌对万古霉素、利福平敏感率较高,对青霉素敏感率最低,分别为100.00%、100.00%;90.00%、100.00%;10.00%、20.00%。铜绿假单胞菌、大肠埃希菌对亚胺培南敏感率最高,对头孢曲松、左氧氟沙星敏感率较低,分别为100.00%、100.00%;33.33%、33.33%;33.33%、0.00%。使用橡皮引流管、使用负压引流、置管时间≥10 d及BMI≥25 kg/m 2的患者围手术期发生手术切口、引流管感染率显著高于使用Y型硅胶多孔引流管、使用逆行冲洗负压引流、置管时间<10 d及BMI<25 kg/m 2的患者(P<0.05)。普通负压引流(OR=4.041)、置管时间≥10 d(OR=3.361)是围手术期手术切口、引流管感染的独立影响因素。结论普通负压引流、置管时间≥10 d是围手术期手术切口、引流管感染的独立影响因素,且病原菌以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌为主。

Objective To investigate the perioperative infection and related risk factors in patients with modified radical mastectomy.Methods A retrospective selection of 120 patients treated with modified radical mastectomy for breast cancer was selected as the research object.Perioperative clinical data were collected from patients and analyzed for risk factors associated with perioperative surgical incision and drainage tube infection.Results 20 cases of incision and drainage tube infection occurred in 120 patients,the infection rate was 16.67%.20 cases of incision and local secretions from the drainage tube were cultured,and a total of 27 pathogenic bacteria were detected,including 19 Gram-positive bacteria(70.37%)and Gram-negative bacteria 8(29.63%).Staphylococcus aureus and Staphylococcus epidermidis have higher sensitivity to vancomycin and rifampicin,and the lowest sensitivity to penicillin were 100.00%,100.00%;90.00%,100.00%;10.00%,20.00%,respectively.Pseudomonas aeruginosa and Escherichia coli had the highest sensitivity to imipenem,and the sensitivity to ceftriaxone and levofloxacin were100.00%,100.00%,33.33%,33.33%,33.33%,and 0.00%,respectively.In patients with rubber drainage tube,negative pressure drainage,catheterization time≥10 d and BMI≥25 kg/m 2,the perioperative period of surgical incision and drainage tube infection rate was significantly higher than using Y-type silica porous tube,using retrograde irrigation negative pressure Patients with drainage,catheterization time<10d and BMI<25kg/m 2(P<0.05).Ordinary negative pressure drainage(OR=4.041)and catheterization time≥10d(OR=3.361)were independent influencing factors of perioperative surgical incision and drainage tube infection.Conclusion Ordinary negative pressure drainage and catheterization time≥10d are independent influencing factors of perioperative surgical incision and drainage tube infection,and the pathogens are Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli.