胸腔闭式引流术后感染患者病原菌分布、危险因素分析及干预措施研究

Distribution of pathogenic bacteria,risk factors and intervention measures in patients with infection after closed thoracic drainage

目的分析胸腔闭式引流术后感染患者病原菌分布特征以及感染危险因素,探讨预防术后感染的措施。方法回顾性选择2014年6月至2018年12月于我院行胸腔闭式引流术的362例患者临床资料,根据是否发生术后感染,将患者分为感染组和未感染组。统计术后感染患者病原菌分布情况,Logistic回归分析胸腔闭式引流术后感染的危险因素,总结预防感染的有效措施。结果本组术后感染32例,感染率8.84%,感染病原菌以细菌(59.38%)为主,65.63%为多重病原菌感染。G-菌株和G+菌株分别以肺炎克雷伯菌(20.00%)和金黄色葡萄球菌(14.55%)检出率最高。单因素分析,年龄、自发性气胸、合并糖尿病、低蛋白血症、慢性阻塞性肺疾病、有创机械通气、引流管留置时间、引流管个数、引流瓶液体、引流口敷料更换时间、围术期抗生素使用时间、联合应用抗生素与胸腔闭式引流术后感染有关(P<0.05),Logistic回归分析示年龄≥65岁(OR=1.857,95%CI 1.032~5.172)、合并糖尿病(OR=2.232,95%CI 1.354~6.275)、合并慢性阻塞性肺疾病(OR=2.036,95%CI 1.245~6.029)、有创机械通气(OR=2.547,95%CI 1.524~8.569)、引流管留置时间≥72h(OR=3.028,95%CI 1.842~12.347)是胸腔闭式引流术后感染的高危因素(P<0.05)。结论胸腔闭式引流术后感染率较高,高龄、合并糖尿病和慢性阻塞性肺疾病、有创机械通气以及长时间留置引流管,是导致感染的危险因素,临床加强对胸腔闭式引流患者感染监测,合理使用抗生素,做好引流管护理,以降低感染率。

Objective To analyze the distribution characteristics of pathogenic bacteria and risk factors of infection after closed thoracic drainage,and to explore the measures to prevent infection after thoracic drainage.Methods 362 patients who underwent closed thoracic drainage in our hospital from June 2014 to December 2018 were retrospectively selected.According to the occurrence of postoperative infection,the patients were divided into the infection group and the non-infection group.The distribution of pathogenic bacteria in patients with post-operative infection was counted.The risk factors of post-operative infection after closed thoracic drainage were analyzed by logistic regression,and the effective measures to prevent infection were summarized.Results There were 32 cases of infection after operation,and the infection rate was 8.84%.The main pathogens were bacteria(59.38%),and multiple pathogens infection rate was 65.63%.The detection rates of Klebsiella pneumoniae(20.00%)and Staphylococcus aureus(14.55%)were the highest among G-strains and G+strains respectively.Univariate analysis found age,spontaneous pneumothorax,diabetes mellitus,hypoproteinemia,chronic obstructive pulmonary disease,invasive mechanical ventilation,drainage tube retention time,number of drainage tubes,drainage bottle fluid and drainage dressing replacement time,perioperative antibiotic use time,and combined use of antibiotics were related to infection after closed thoracic drainage surgery(P<0.05).Logistic regression analysis showed that age≥65 years old(OR=1.857,95%CI 1.032~5.172),diabetes mellitus(OR=2.232,95%CI 1.354~6.275),chronic obstructive pulmonary disease(OR=2.036,95%CI 1.245~6.029),invasive mechanical ventilation(OR=2.547,95%CI 1.524~8.569),and indwelling time of drainage tube≥72 hours(OR=3.028,95%CI 1.842~12.347)were the high risk factors of infection after closed thoracic drainage(P<0.05).Conclusion The infection rate after closed thoracic drainage is higher.Senile age,diabetes mellitus and chronic obstructive pulmonary disease,invasive mechanical ventilation and long-term indwelling drainage tube are the risk factors of infection.Clinical monitoring of infection in patients with closed thoracic drainage should be strengthened,antibiotics should be used reasonably,and drainage tube nursing should be done well to reduce infection rate.