结直肠癌术后发生医院感染的临床分析

摘要

目的：探讨结直肠癌术后切口感染的相关因素和病原菌的分布情况，以进一步提高结直肠癌术后切口感染的防治效果。方法回顾性分析自2010年8月至2014年8月在江油市第二人民医院普外科接受手术治疗的结直肠癌患者294例。根据有无发生术后切口感染将其分为感染组（49例）和未感染组（245例）。采集感染组患者的术口分泌物行病原学检测以分析结直肠癌术后切口感染的病原菌分布情况。同时对比两组患者的临床资料，以探讨造成结直肠癌术后切口感染的因素。结果本研究患者结直肠癌术后切口感染率为16．7％，共培养出病原菌59株。革兰阴性菌占66．1％，革兰阳性菌占30．5％。革兰阴性菌中，大肠埃希菌最多，有16株，其次为铜绿假单胞菌，有9株；革兰阳性菌中，金黄色葡萄球菌最多，有13株。感染组和未感染组患者的性别、年龄、有无合并肠梗阻的对比，差异均无统计学意义（ P＞0．05）；感染组体质指数≥23 kg／m2的患者比例为30．6％，显著高于未感染组（ P＜0．05），感染组合并糖尿病患者的比例为26．5％，显著高于未感染组（ P ＜0．05）。结论结直肠癌术后切口感染病原菌以革兰阴性菌为主，肥胖和合并糖尿病是术后切口感染的相关因素。临床应加强血糖的管理，规范使用抗菌药物以提高术口感染的防治效果。%Objective To explore the related factors of nosocomial infection after colorectal cancer sur-gery and the distribution of pathogenic bacteria,in order to further enhance the prevention and treatment of infection after colorectal cancer surgery.Methods Clinical data of 294 patients with colorectal cancer received surgeries in Jiangyou Second Pepole′s Hospital from Aug.2010 to Aug.2014 were retrospectively analyzed.According to the presence of wound infections after surgery,all the cases were divided into infection group(49 cases) and uninfected group(245 cases).Excretions from the wounds of patients in infection group were collected and underwent pathogen detection to analyze the distribution of pathogens in the wounds of patients after colorectal cancer surgery.Clinical data of the two groups was further compared,in order to investigate the factors that lead to wound infection after colorectal cancer surgery.Results The wound infec-tion rate of all the patients was 16.7%,pathogens cultured were 59 strains totally,among which gram-nega-tive bacteria accounted for 66.1%,gram-positive bacteria accounted for 30.5%.Among gram-negative bacte-ria,e.coli accounted for the most,16 strains,followed by pseudomonas aeruginosa,9 strains;among gram-positive bacteria,staphylococcus aureus accounted for the most,13 strains.There were no statistically signifi-cant differences of gender,age,presence of intestinal obstruction between the two groups(P>0.05);Propor-tion of patients with BMI≥23 kg/m2 in the infection group was 30.6%, significantly higher than that in the uninfected group(P <0.05),proportion of patients complicated by diabetes in the infection group was 26.5%,significantly higher than that in the uninfected group(P<0.05).Conclusion Pathogens of wound infection after colorectal cancer surgery are mainly gram-negative bacteria,obesity and diabetes mellitus is the related factors of postoperative wound infection.It is suggested that blood sugar management should be strengthened in clinic,and the use of antibacterial drugs should be standardized in order to improve effect of prevention and treatment of wound infection.