腹腔镜小儿肠套叠术后医院感染的病原学特点及炎性因子表达对其预后的影响分析

Etiological characteristics of postoperative nosocomial infection in children undergoing laparoscopic intussusception surgery and impact of expression of inflammatory factors on prognosis

目的 研究分析腹腔镜小儿肠套叠术后医院感染的病原学特点及炎性因子表达对其预后的影响。方法选择2013年6月-2014年9月于医院接受腹腔镜下肠套叠复位术后感染的68例患儿作为研究对象,观察患儿术后医院感染的感染部位及病原学特点,分析患儿炎症因子表达水平与预后的关系。结果 68例感染患儿感染部位主要以肠道菌群失调为主,占39.71%;采集62例次临床标本进行病原菌培养,共检出36株病原菌,革兰阴性菌18株(50.00%)、革兰阳性菌13株(36.11%)、真菌5株(13.89%)。主要革兰阴性菌大肠埃希菌及铜绿假单胞菌对美罗培南、左氧氟沙星、阿米卡星、头孢哌酮等药物敏感性较高,对头孢噻肟、头孢曲松、氨苄西林、阿莫西林及头孢唑林耐药性较高,主要革兰阳性菌金黄色葡萄球菌对青霉素、红霉素、阿奇霉素、左氧氟沙星、庆大霉素及克林霉素等药物耐药性较高,对替考拉宁、万古霉素等药物敏感性较高。随治疗时间的延长,IL-2、IL-4、IL-6、IL-10、hs-CRP、TNF-α等炎性因子水平均较治疗前降低(P<0.05)。结论 对腹腔镜下肠套叠复位术后感染患儿进行抗炎治疗时应注意结合药敏试验结果用药,密切注意患儿血清各炎症因子水平的变化,有助于改善患儿预后及感染状态,减轻家庭的经济负担,提高患儿生活质量。

OBJECTIVE To explore the etiological characteristics of postoperative nosocomial infection in children undergoing laparoscopic intussusception surgery and observe the impact of expression of inflammatory factors on prognosis.METHODS From Jun 2013to Sep 2014,a total of 68children who had nosocomial infection after the laparoscopic intussusception surgery were recruited as the study objects,the infection sites and etiological characteristics of postoperative nosocomial infection were observed,and the correlation between the levels of inflammatory factors and the prognosis was analyzed.RESULTS Of 68children with infection,39.71%had alteration of intestinal flora.Totally 36strains of pathogens were isolated from clinical specimens that were obtained from 62casetimes of children with the infection,18(50.00%)of which were gram-negative bacteria,13(36.11%)were grampositive bacteria,and 5(13.89%)were fungi.Escherichia coli and Pseudomonas aeruginosa were the predominant species of gram-negative bacteria and were highly susceptible to meropenem,levofloxacin,amikacin and cefoperazone but were highly resistant to cefotaxime,ceftriaxone,ampicillin,amoxicillin and cefazolin.Staphylococcus aureus was dominant among the gram-positive bacteria and was highly resistant to penicillin,erythromycin,azithromycin, levofloxacin,gentamicin and clindamycin but was highly susceptible to teicoplanin and vancomycin.The levels of inflammatory factors such as IL-2,IL-4,IL-6,IL-10,hs-CRP and TNF-αwere significantly lower after the treatment than before the treatment(P<0.05).CONCLUSIONIt is necessary to reasonably use antibiotics for the laparoscopic intussusception surgery children with postoperative nosocomial infection based on the result of drug susceptibility testing and pay close attention to the changes of serum inflammatory factors so as to improve the prognosis of the children with infection,lighten the economic burden and raise the quality of life of the children.