【摘要】 目的探讨食管贲门癌患者术后肺部感染的相关危险因素及诊治对策,以提高医疗服务质量。方法回顾性分析医院2012年1月-2013年1月146例手术治疗食管贲门癌患者资料,对感染高危因素进行分析,采用SPSS13.0软件进行统计处理。结果 146例患者中27例发生术后肺部感染,感染率为18.49%;手术时间、病程、年龄、合并基础疾病、手术切口长度、营养状况、预防性使用抗菌药物、吸烟、未采用术后自控镇痛等与肺部感染密切相关(P<0.05);共培养出病原菌27株,革兰阴性菌19株占70.37%,以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍氏不动杆菌为主,革兰阳性菌8株占29.63%,以金黄色葡萄球菌、表皮葡萄球菌为主;革兰阴性菌对氨苄西林、左氧氟沙星高度耐药,革兰阳性菌对万古霉素、亚胺培南敏感性较高。结论术前综合评价,掌握手术指征,发现肺部潜在疾患,合理的手术方案、娴熟的手术操作技术可降低肺部创伤,术后针对感染高危因素进行干预是降低患者肺部感染率与控制感染的有效措施。更多还原

【Abstract】 OBJECTIVE To explore the related risk factors for postoperative pulmonary infections in the patients with esophageal and cardiac cancer and put forward diagnosis and treatment countermeasures so as to improve quality of medical service.METHODS The clinical data of 146cases of esophageal and cardiac cancer who underwent surgery from Jan 2012 to Jan 2013 were retrospectively analyzed,then the high risk factors for the postoperative infections were analyzed,and the statistical analysis was performed with the use of SPSS13.0software. RESULTS Of all the 146patients,the postoperative pulmonary infections occurred in 27cases with the infection rate of 18.49%.The incidence of the postoperative pulmonary infections was closely related to the operation duration,disease course,age,complication of underlying disease,length of surgical incision,nutrition status,antibiotics prophylaxis,smoking,and without adoption of postoperative self-control analgesia(P<0.05).A total of 27 strains of pathogens have been isolated,among which there were 19(70.37%)strains of gram-negative bacteria and 8(29.63%)strains of gram-positive bacteria;the Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,and Acinetobacter baumannii were the dominant among the gram-negative bacteria;the Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of gram-positive bacteria.The gram-negative bacteria were highly resistant to ampicillin and levofloxacin,while the gram-positive bacteria were highly susceptible to vancomycin and imipenem.CONCLUSIONIt is an effective way to conduct preoperative comprehensive evaluation,grasp surgical indications,find out potential pulmonary diseases,adopt reasonable surgery program,master skillful operation procedures to reduce the pulmonary injuries,and take intervention measures in response to the high risk factors so as to effectively reduce the incidence of postoperative pulmonary infections.更多还原