摘要
目的探讨胸外科食管癌术后发生肺部感染的易感因素及病原菌种类、药敏试验结果,以期探讨食管癌术后肺部感染的高危因素,并为临床应用抗生素提供参考。方法回顾性分析2016年9月～2018年5月在潍坊市人民医院胸外科收治的食管癌手术患者215例,对其临床资料进行回顾性分析,所有患者均在手术后第2天采集痰液标本并及时送至微生物实验室进行痰培养,培养结果为阳性的标本进一步行菌株分离及药敏试验,统计病原菌分类及其药敏试验结果。结果患者>60岁、长期吸烟(≥20年)、术前合并症(糖尿病、COPD)、肿瘤部位高、病理分期晚是食管癌术后并发肺部感染的独立危险因素;215例手术患者术后发生肺部感染84例,其中痰培养检出病原菌的患者78例,共检出病原菌103株,以革兰氏阴性菌为主,共87株(86.40%),其中鲍曼不动杆菌在革兰阴性菌中对抗生素耐药性较高,属于革兰阳性菌的金黄色葡萄球菌对大多数抗菌药物表现出强耐药性。结论高龄、吸烟、合并糖尿病和COPD、肿瘤位置偏高及肿瘤病情较晚是食管癌术后肺部感染的危险因素,肺部感染病原菌以革兰氏阴性菌为主,主要对哌拉西林、氨曲南、庆大霉素、妥布霉素、氨苄西林产生耐药性,而对美洛培南、亚胺培南、万古霉素敏感性较高,临床工作中应注意合理应用抗生素。
Objective To explore the susceptibility factors,pathogenic bacteria types and drug susceptibility test results of pulmonary infection after thoracic surgery for esophageal cancer,so as to explore the high-risk factors of pulmonary infection after esophageal cancer,and provide references for clinical application of antibiotics.Methods A retrospective analysis in September 2016 to May 2018 thoracic surgery in weifang people’s hospital treated 215 cases of patients with esophageal cancer surgery,the clinical data were analyzed retrospectively,all patients were the second day after surgery collecting sputum specimens and promptly sent to the microbiology laboratory of sputum culture,cultivate the positive specimens further strain separation and drug sensitive test,statistical classification of pathogenic bacteria and their drug susceptibility test results.Results The advanced age over 60 years,long-term smoking,preoperative complications,tumor site and pathological stage were independent risk factors for pulmonary infection after esophageal cancer.215 surgical patients postoperative pulmonary infection in 84 cases,with 78 cases patients with sputum culture detection of pathogenic bacteria,a total of 103 strains pathogenic bacteria detection is given priority to with gram-negative bacteria,a total of 87 strains,accounting for 86.40%,including acinetobacter baumannii in gram-negative bacteria to antibiotic resistance is higher,belong to gram-positive bacteria staphylococcus aureus showed strong resistance to most antimicrobial agents.Conclusion Age,smoking,diabetes mellitus,and COPD,tumor location is on the high side and tumor disease is late esophageal risk factors of postoperative pulmonary infection,pulmonary infection pathogenic bacteria is given priority to with gram-negative bacteria,it is mainly resistant to piperacillin,aztreonam,gentamicin,tobramycin,and ampicillin,but highly sensitive to metopenem,imipenem,and vancomycin.Therefore,antibiotics should be reasonably applied in clinical work.
作者
范超
胡德宏
李伟
FAN Chao;HU Dehong;LI Wei(Department of Surgery,Weifang Medical University,Weifang 261053,China;Department of Thoracic Surgery,Weifang People's Hospital)
出处
《潍坊医学院学报》
2019年第2期81-84,共4页
Acta Academiae Medicinae Weifang
关键词
食管肿瘤
肺部感染
危险因素
病原菌
药敏试验
Esophageal cancer
Pulmonary infection
Risk factors
Drug sensitive test
