口腔颌面肿瘤术后感染病原学及影响因素

Etiological characteristics and influencing factors for postoperative infection in patients with oral and maxillofacial tumors

目的探讨口腔颌面肿瘤术后感染的病原学特点及其影响因素。方法回顾性分析2017年3月-2020年3月郑州人民医院口腔科入院接受手术治疗的口腔颌面肿瘤患者150例,分为术后感染组及未感染组,统计两组临床资料,对感染组感染部位及病原菌分布进行统计,利用Logistic回归模型分析患者术后感染的影响因素。结果 150例口腔颌面肿瘤患者发生术后感染20例,占比13.33%,主要为切口感染13例、下呼吸道感染5例;共检出病原菌26株,主要为革兰阳性菌16株占比61.54%,革兰阴性菌8株占比30.77%;单因素分析结果显示,不同年龄、糖尿病史、口腔环境、手术方式、术中抗菌药物使用情况、手术时间、术后引流管放置情况及住院时间的口腔颌面肿瘤患者术后感染率的比较,差异有统计学意义(P<0.05);Logistic回归分析结果显示,口腔牙周结石Ⅲ度、采用扩大切除+颈淋巴结清扫+修复重建手术方式是影响口腔颌面肿瘤患者术后感染的独立危险因素(P<0.05)。结论口腔颌面肿瘤患者术后感染主要以手术切口感染为主,主要病原菌为革兰阳性菌,口腔环境与手术方式是患者术后感染的独立危险因素,提示临床医师术前应积极改善患者口腔环境,结合患者自身情况,制定手术方案,以降低患者术后感染的发生率。

OBJECTIVE To explore the etiological characteristics and influencing factors for postoperative infection in patients with oral and maxillofacial tumors.METHODS Totally 150 patients with oral and maxillofacial tumors who received surgical procedures in stomatology department of Zhengzhou People′s Hospital from Mar.2017 to Mar.2020 were retrospectively analyzed and were divided into the infection group and the non-infection group.The clinical data of the two groups of patients were statistically analyzed,the infection sites of the infection group and the distribution of pathogens were statistically analyzed,and the influencing factors for the postoperative infection were analyzed by means of logistic regression model.RESULTS Among the 150 patients with oral and maxillofacial tumors,20 had postoperative infection,accounting for 13.33%,13 of whom had incision infection,and 5 had lower respiratory tract infection.Totally 26 strains of pathogens were isolated,16(61.54%) of which were gram-positive bacteria,and 8(30.77%) were gram-negative bacteria.The result of univariate analysis showed that there was significant difference in the incidence of postoperative infection among the oral and maxillofacial tumor patients with different age,history of diabetes mellitus,oral environment,surgical mode,intraoperative use of antibiotics,operation duration,postoperative drainage tube indwelling and length of hospital stay(P<0.05).The result of logistic regression analysis indicated that the grade Ⅲ oral periodontal stones and extended resection plus neck lymph node dissection plus repair and reconstruction were independent risk factors for the postoperative infection in the patients with oral and maxillofacial tumors(P<0.05).CONCLUSION The patients with surgical incision infection are dominant among the oral and maxillofacial tumor patients with postoperative infection.The gram-positive bacteria are the predominant pathogens.Oral environment and surgical mode are the independent risk factors for the postoperative infection,it is suggested that the clinicians should actively improve the oral environment of the patients before surgery and take targeted surgical interventions based on the patients′ own condition so as to reduce the incidence of postoperative infection.