| 马加贵 安建雄 王文璋 李喜元 张春芳 李灯凯 蔡爱兵.心脏外科术后深部胸骨切口感染的流行病学特点及病原体分层[J].,2017,17(2):290-294 |
| 心脏外科术后深部胸骨切口感染的流行病学特点及病原体分层 |
| Epidemiological Characteristics and Pathogen Stratification of Deep SternalWound Infection after Cardiac Surgery |
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| DOI： |
| 中文关键词: 心脏外科手术 深部胸骨切口感染 流行病学特点 病原体分层 |
| 英文关键词: Cardiac surgery Deep sternal wound infection Epidemiological characteristic Pathogen stratification |
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| 中文摘要: |
| 目的：探讨心脏外科术后深部胸骨切口感染(Deep sternal wound infection，DSWI)患者的流行病学特点及病原体分层。方法：
回顾性分析2012 年1 月至2014 年12 月中国医科大学航空总医院心胸外科84 例接受肌瓣修复重建手术治疗的心脏手术后
DSWI患者的临床资料。结果：①84 例DSWI患者平均年龄54.6± 14.8 岁，其中女性患者34 例(40.5%)，初始手术类型中，冠状动
脉旁路移植术CABG 患者最常见，43 例(51.2%)；DSWI 患者在ICU 住院时间1.3± 2.9 天，总住院时间27.7± 14.5 天，医疗费用
45025± 29547 元(人民币)。DSWI 患者最常见的始发症状为发热和伤口裂开、分泌脓性分泌物。②84 例DSWI 患者中37 例
(44.0%)有明确病原学诊断，最常见的病原菌为革兰阴性杆菌(Gram-negative bacilli，GNB)(54.8%)，GNB中最常见的是铜绿假单胞
菌，其次是鲍曼不动杆菌。③主动脉手术患者(4/9，44.4%)与CABG 患者(6/43，14.0%)、瓣膜置换术患者(2/15，13.3%)比较，更易并
发革兰阳性球菌相关性DSWI；吸烟、CABG 患者易感染革兰阴性杆菌。革兰阴性杆菌相关性DSWI 患者ICU住院时间(2.3± 4.3
天vs.1.9± 4.0 天)、总住院时间(31.2± 17.7 天vs.30.3± 19.4 天)更长，医疗费用更高(55702± 33822 元vs.52389± 40967 元)，尽管
没有统计学意义。结论：革兰阴性杆菌是DSWI最常见的病原菌，由革兰阴性杆菌引起的DSWI 进一步增加了患者的医疗负担，
且某些DSWI危险因素可能与特定的病原学有关。 |
| 英文摘要: |
| Objective:To investigate the epidemiological characteristics and pathogen stratification of patients with deep sternal
wound infection after cardiac surgery.Methods:This was a retrospective study from January 2012 to December 2014, 84 (age≥ 18years)
patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department.Results:Among these 84 patients, 34(40.5%) were females and the mean age was 54.6± 14.8 years; CABG was performed in 43 patients (51.2%)
in Initial operations of 84 patients, Total postsurgical stay in the intensive care unit was 1.3± 2.9 days, Hospital stay was 27.7± 14.5
days, and Hospitalization cost RMB was 45025± 29547 yuan. The most common symptoms of DSWI were fever and purulent exudate
with wound dehiscence. Microbiological diagnosis was available in 37 patients.The organisms most commonly isolated in patients with
DSWI were gram negative bacilli (54.8%), was the most common GNB, followed by .
Compared to CABG patients(6/43, 14.0%) and valve replacement patients(2/15,13.3%), aortic surgery patients(44.4%,4/9) more easily
complicated with gram positive cocci associated DSWI; Smoking and CABG patients easily infected with Gram negative bacilli;
Compared to grampositive cocci group, gramnegative bacilli in correlation DSWI had longer in ICU hospitalization days (2.3± 4.3days
vs.1.9± 4.0 days), total hospitalization days(31.2± 17.7 days vs.30.3± 19.4 days) and more higher in Hospitalization cost(55702± 33822
yuan vs.52389± 40967 yuan), although it was not statistically significant.Conclusion:Gram negative bacilli are the most common
pathogenic bacteria in DSWI. Compared with DSWI patients infected with other pathogens, the DSWI caused by Gram negative bacilli
may further increase the patient's medical burden, DSWI risk factors may be related to specific pathogens. |
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