结直肠癌患者术后并发腹腔感染的危险因素分析及对策研究

摘要

目的 探讨结直肠癌患者术后并发腹腔感染的危险因素及相应的对策.方法 选择行手术治疗的182例结直肠癌患者,其中术后并发腹腔感染的患者共16例,采集感染患者的腹腔引流脓液等标本进行细菌培养、鉴定及药敏实验,并对术后并发腹腔感染的危险因素进行分析.结果 共检出153株病原菌,其中革兰阳性菌占19.61%,以金黄色葡萄球菌为主,占7.84%;革兰阴性菌占73.20%,以大肠埃希菌(37.91%)、克雷伯菌属(20.26%)、铜绿假单胞菌(7.19%)为主.大肠埃希菌的耐药性较差,仅对克林霉素的耐药性>50%;克雷伯菌属对克林霉素、四环素、环丙沙星的耐药性>50%;金黄色葡萄球菌对亚胺培南、头孢他啶、环丙沙星的耐药性<50%;铜绿假单胞菌对妥布霉素、亚胺培南、头孢他啶、环丙沙星的耐药性<50%.经logistic回归分析,合并糖尿病、血清蛋白<35 g/L、肿瘤分期≥Ⅲ期、出血量≥300 ml、术区污染、手术时间≥180 min是影响结直肠癌患者术后并发腹腔感染的独立危险因素.结论 合并糖尿病、血清蛋白<35 g/L、肿瘤分期≥Ⅲ期、出血量≥300 ml、术区污染、手术时间≥180 min是影响结直肠癌患者术后并发腹腔感染的独立危险因素.针对危险因素积极采取相应的对策,以降低结直肠癌手术患者术后并发腹腔感染的发生率.在治疗结直肠癌患者术后并发腹腔感染时要合理对抗菌药物进行选择,并及时进行病原菌培养和药敏实验.%Objective To explore the risk factors for abdominal infection in colorectal cancer patients after surgery and the corresponding countermeasures.Methods 182 cases of patients with colorectal cancer were selected,16 cases had abdominal infection after operation,peritoneal drainage pus specimens were collected for bacterial culture,identification and drug sensitivity test,and the postoperative abdominal infection and risk factors analysis.Results There were 153 strains of pathogenic bacteria, gram positive bacteria accounted for 19.61%,Staphylococcus aureus,accounted for 7.84%;gram negative bacteria accounted for 73.20%,Escherichia coli(37.91%),Klebsiella pneumoniae(20.26%),Pseudomonas aeruginosa(7.19%).The poor resist-ance of Escherichia coli,only to clindamycin resistance >50%;Klebsiella to clindamycin,tetracycline,ciprofloxacin resistance>50%;Staphylococcus aureus to imipenem,ceftazidime,ciprofloxacin resistance 50%;Pseudomonas aeruginosa to tobramycin, imipenem,ceftazidime,ciprofloxacin resistance is less than 50%.By logistic regression analysis,diabetes mellitus,serum protein<35 g/L,tumor stage≥Ⅲ,and the amount of bleeding≥300 ml,postoperative pollution,operation time≥180 min of postoper-ative patients with colorectal cancer complicated with abdominal infection were independent risk factors.Conclusion Diabetes mellitus,serum protein<35 g/L,tumor stage≥Ⅲ,and the amount of bleeding≥300 ml,postoperative pollution,operation time≥180 min of postoperative patients with colorectal cancer complicated with abdominal infection are independent risk factors.Tak-ing appropriate measures to reduce the incidence of postoperative abdominal infection in patients with colorectal cancer surgery.In the treatment of colorectal cancer patients complicated with abdominal infection should choose reasonable antimicrobial agents,and timely pathogenic bacteria culture and drug sensitivity test.