全身麻醉对骨科患者术后感染情况及炎症因子分析

Clinical significance of general anaesthesia in postoperative infection and changes of CRP,PCT and IL-6 levels in orthopedic patients

目的探讨全身麻醉对骨科患者术后感染病原菌与耐药性及炎症因子情况。方法选择2012年12月-2017年12月医院收治的行全身麻醉骨科手术患者741例为研究对象,分析术后感染情况,并对感染患者进行病原菌及药敏分析;于术后第1天、术后第3天和术后第5天检测血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)。结果行全身麻醉骨科手术患者术后感染率为4.05%(30/741);感染部位以切口为主;共培养分离病原菌43株,其中革兰阴性菌25株占58.14%,以鲍氏不动杆菌和铜绿假单胞菌为主;革兰阳性菌18株占41.86%,以金黄色葡萄球菌为主;主要革兰阴性菌对头孢他啶、头孢哌酮/舒巴坦耐药率均>80%,鲍氏不动杆菌对氨曲南和亚胺培南较敏感,铜绿假单胞菌对美罗培南较敏感;主要革兰阳性菌对青霉素G和红霉素耐药率较高,未检出对万古霉素和替考拉宁耐药的菌株。感染患者术后第1天、第3天和第5天血清CRP分别为(40.83±5.61)mg/L、(56.98±7.13)mg/L、(65.91±4.65)mg/L、PCT分别为(0.27±0.04)ng/ml、(0.49±0.07)ng/ml、(0.61±0.11)ng/ml、IL-6分别为(35.41±4.56)ng/L、(43.98±5.71)ng/L、(56.90±6.52)ng/L高于未感染患者(P<0.001)。结论行全身麻醉骨科手术患者术后感染以革兰阴性菌为主,建议临床选用敏感抗菌药物进行治疗;术后感染患者血清炎症因子升高,故早期抗感染治疗具有重要意义。

OBJECTIVE To investigate the clinical significance of general anesthesia in the distribution and drug resistance of pathogens,and the levels of C reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)in orthopedic patients after surgery.METHODS 741 patients who underwent orthopaedic surgery with general anesthesia in the hospital during Dec.2012-Dec.2017 were selected as subjects,and the postoperative infection was analyzed.The pathogenic bacteria were isolated and cultured,and the drug resistance test was carried out.The levels of serum CRP,PCT and IL-6 on day 1,day 3 and day 5 after operation were determined.RESULTS There were 30 cases of postoperative infection in 741 patients undergoing general anesthesia in department of orthopedics,and the infection rate was 4.05%.The infection site was dominated by incisional infection,accounting for53.33%.43 strains of pathogenic bacteria were isolated from infected patients,of which 25 strains were gram-negative bacteria and 18 strains were gram-positive bacteria.Gram-negative bacteria were mainly Acinetobacter baumannii and Pseudomonas aeruginosa,whereas gram-positive bacteria were mainly Staphylococcus aureus.The resistance rates of the major gram-negative bacteria to ceftazidime,and cefoperazone/sulbactam were both>80%.A baumannii was relatively sensitive to aztreonam and imipenem.whereas P aeruginosa was relatively sensitive to meropenem.The resistance rates of the major gram-positive bacteria to penicillin G and erythromycin were relatively higher,whereas no vancomycin and tekolanin-resistant strains were detected.The serum levels of CRP were(40.83±5.61)mg/L,(56.98±7.13)mg/L,(65.91±4.65)mg/L,PCT were(0.27±0.04)ng/ml,(0.49±0.07)ng/ml,(0.61±0.11)ng/ml,IL-6 were(35.41±4.56)ng/L,(43.98±5.71)ng/L,(56.90±6.52)ng/L in infected patients on the first,third and fifth day after operation,which were significantly higher than those in uninfected patients(P<0.001).CONCLUSION Gram-negative bacteria are the main pathogens of postoperative infections in orthopedic patients after general anesthesia,and it is recommended to use sensitive antimicrobial agents in clinic.The levels of serum CRP,PCT and IL-6 in patients with postoperative infections are significantly higher,so early anti-infection treatment is of great significance.