心脏术后深部胸骨伤口感染的外科处理

目的探讨胸骨正中切口心脏术后深部胸骨伤口感染的外科治疗策略。方法采用回顾性调查方法 ,选择中国医学科学院北京协和医院2003年1月~2014年7月入院经胸骨切开心脏术后发生深部胸骨伤口感染的患者为研究对象,对深部胸骨伤口感染的特点及治疗措施进行分析。结果 2936例患者中28例出现深部胸骨伤口感染,感染率为0.95%,术后感染发生于术后第7天~12个月,术后1个月内发生感染24例,术后14 d内发生感染22例。28例感染患者中,8例患者应用了闭式负压吸引技术;12例接受了保留胸骨再固定胸骨术;4例切除部分胸骨再固定胸骨术;2例彻底清创胸骨、胸大肌肌瓣移植术;7例彻底清创胸骨、腹直肌肌皮瓣移植术;3例未手术治疗。28例感染患者中,死亡5例,其余无感染复发,均恢复正常生活或工作。结论首选保留胸骨再固定术可作为治疗深部胸骨伤口感染的基本原则,对于胸骨感染高风险的患者,胸骨切除及组织瓣移植术是一种有效的治疗手段。     

阑尾炎手术切口感染后抗菌药物治疗的应用

目的 了解我院阑尾炎手术后切口感染合理应用抗菌药物的治疗效果,为临床合理应用抗菌药物提供参考.方法 回顾性分析我院自2008年5月~2010年12月的475例阑尾炎手术患者,术后发生切口感染进行抗菌药物治疗的患者106例,对抗菌药物的品种选择、联合用药、用药时间以及不合理用药等情况进行统计分析.结果 126例阑尾炎术后切口感染患者抗菌药物的使用率为100.00%,其中抗茵药物使用率较高的药品为甲硝唑、氨曲南、头孢呋辛钠、左氧氟沙星、加替沙星.结论 我院行阑尾炎术的患者,应用抗菌药物预防切口感染,但是在应用过程中存在预防性用药时间偏长、起点偏高,少数药物联用方式不当的问题,因此应加大医院的管理力度,逐渐改善抗菌药物的应用现状.     

Risk factors for wound infection after minor surgery in general practice

OBJECTIVE: To determine the incidence of and risk factors for surgical site infections in general practice. DESIGN: Prospective, observational study of patients presenting for minor excisions. SETTING: Primary care in a regional centre, Queensland, October 2004 to May 2005. PARTICIPANTS: 857 patients were assessed for infection. RESULTS: The overall incidence of infection was 8.6% (95% CI, 3.5%-13.8%). Excisions from lower legs and feet (P = 0.009) or thighs (P = 0.005), excisions of basal cell carcinoma (P = 0.006) or squamous cell carcinoma (P = 0.002), and diabetes (P < 0.001) were independent risk factors for wound infection. CONCLUSION: Our results indicate the high-risk groups for surgery in a general practice setting, such as people with diabetes and those undergoing excision of a non-melanocytic skin cancer or excision from a lower limb. Recognition of these groups could encourage more judicial use of prophylactic antibiotics and use of other interventions aimed at reducing infection rates.     

Tinidazole in the prevention of wound infection after elective colorectal surgery.

During the first six months of 1978, 71 patients were the subject of a controlled trial of the use of tinidazole for the prevention of wound infection after elective colonic surgery. The trial design was prospective, randomized and double-blind with tinidazole or placebo given at the last oral intake before operation. The objective endpoint of the trial was the presence or absence of wound infection manifested by pus. All patients underwent a standard preoperative preparation of bowel washouts, and a standardized surgical technique included, in all cases, the use of wound drainage. At the end of the trial there were three wound infections in 40 patients who were given tinidazole, and eleven wound infections in 31 patients who were given placebo. The difference in wound infection rate between these two groups is significant (x2 with Yates correction = 7.3; P less than 0.01).     

预防阑尾炎术后切口感染的体会

目的探讨阑尾炎切除术后切口感染的预防措施。方法对236例阑尾炎切除术采取正确保护切口，用碘伏浸泡切口，吸干切口组织间隙液，术后碘伏纱布湿敷等预防切口感染措施。结果单纯性阑尾炎与慢性阑尾炎共59例，无术后切口不良反应及感染；化脓性及坏疽性阑尾炎158例中，3例术后切口轻度红肿经治疗后一期愈合，1例切口脂肪液化三期愈合；阑尾穿孔伴腹膜炎18例中，1例术后切口轻度红肿经治疗后一期愈合，1例切口感染。结论对阑尾炎术后切口进行有针对性的预防感染，能有效降低感染率，提高治愈率。     

预防阑尾炎术后切口感染的体会

目的 探讨阑尾炎切除术后切口感染的预防措施.方法 对236例阑尾炎切除术采取正确保护切口,用碘伏浸泡切口,吸干切口组织间隙液,术后碘伏纱布湿敷等预防切口感染措施.结果 单纯性阑尾炎与慢性阑尾炎共59例,无术后切口不良反应及感染;化脓性及坏疽性阑尾炎158例中,3例术后切口轻度红肿经治疗后一期愈合,1例切口脂肪液化三期愈合;阑尾穿孔伴腹膜炎18例中,1例术后切口轻度红肿经治疗后一期愈合,1例切口感染.结论 对阑尾炎术后切口进行有针对性的预防感染,能有效降低感染率,提高治愈率.     

Pseudomonas sternotomy wound infection and sternal osteomyelitis. Complications after open heart surgery.

Pseudomonas aeruginosa sternotomy wound infections occurred in five patients who underwent open heart surgery. The initial isolate in each case was from a mediastinal chest tube routinely cultured on removal. Soft-tissue infection developed in two patients, and sternal osteomyelitis developed in three patients. Pseudomonas-typing studies showed a correlation between five isolates from chest-tube suction pumps used postoperatively and the wound isolates. Analysis of antibiograms of Pseudomonas wound isolates from the cardiac surgery ward from 1975 to 1977 showed eight of 15 with the same antibiogram as the sternotomy pathogens, compared with two of 13 isolates from other wards.     

Collagen as a drug carrier for deep sternal wound infection after open heart surgery

How to optimally treat deep sternal wound infection after open wound infection remains controversial. Biomaterial advances have made local antibiotics-releasing systems a promising alternative for treating deep sternal wound infection. Two patients with deep sternal wound complications were treated with radical wound debridement, sternal refixation, retrosternal suction drainage, bilateral pectoralis major muscle flaps and placement of collagenous drug carriers loaded with vancomycin underneath, above and between the sternal edges. No treatment failure and death occurred in these patients. There were no side effects, treatment failures or deaths after adjuvant treatment with collagenous vancomycin. Preliminary results of these 2 case studies demonstrate the feasibility of successfully treating deep sternal wound infections with collagenous vancomycin in combination with surgical debridement. This technique is easily performed, reliable and safe.     

心脏外科术后深部胸骨切口感染的临床特点及病原菌耐药性分析

目的 观察心脏外科术后深部胸骨切口感染(deep sternal wound infection,DSWI)的临床特点,并进行病原菌耐药性分析.方法 回顾性分析2012-2014年中国医科大学航空总医院心胸外科84例采用肌瓣修复重建手术治疗的心脏手术后DSWI患者(年龄≥18岁)的临床资料,并对DSWI患者的病原菌分布及其耐药性进行分析.结果 ①Ⅱ型DSWI最多见(49/84,58.3％),Ⅰ型有17例(20.2％),Ⅲ型有18例(21.4％).Ⅰ型和Ⅱ型DSWI患者具有典型的临床表现如发热、伤口裂开和/或脓性分泌物、手术区域自发性疼痛、血象升高等.Ⅰ型DSWI患者更易合并低蛋白血症(P＜0.01),早期X线或CT扫描可发现纵隔增宽(P＜0.01).部分Ⅲ型DSWI患者仅表现为手术区域局部症状.②37例(44.0％)患者有明确病原学诊断,最常见的病原菌为革兰阴性杆菌(Gram-negative bacilli,GNB;54.8％),其次为甲氧西林敏感金黄色葡萄球菌(23.7％);GNB中最常见的是铜绿假单胞菌,其次是鲍曼不动杆菌和阴沟肠杆菌.③铜绿假单胞菌对亚胺培南和美罗培南的耐药率均为18.2％,鲍曼不动杆菌对临床常用抗菌药物耐药率均在70％以上,阴沟肠杆菌对大部分常用抗菌药物未表现耐药性.金黄色葡萄球菌和表皮葡萄球菌对青霉素G的耐药率均为100％,对克林霉素的耐药率均在80％以上,但对替加环素、万古霉素和利奈唑胺未表现出耐药.结论 DSWI多发生在心脏术后1个月内,其中Ⅱ型DSWI最多见,且不同类型的DSWI主要临床表现不同;DSWI常见的病原菌为革兰阴性杆菌及金黄色葡萄球菌,且对常用抗菌药物的耐药率高.     

Negative-pressure wound therapy and external fixation for infection and hematoma after hallux abducto valgus surgery

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications.     

腹腔镜胆囊切除术后切口感染相关因素分析

目的总结分析与腹腔镜胆囊切除术（LC）后切口感染发生相关的因素。方法回顾分析我院2006年3月~2009年3月进行的738例LC患者的临床资料,进行比较分析。结果 LC术后切口感染总体发生率为5.01%,均发生于剑突下切口。感染的发生与患者的年龄、性别以及是否合并糖尿病无关（P〉0.05）,而与手术的时机、胆囊病变的类型、术中胆囊破裂与否以及手术进行的时间有关（P〈0.05）。结论临床医生应该总结经验、规范操作、降低切口感染的发生率。     

真空负压引流瓶在创伤急诊术后的应用分析

目的:探讨真空负压引流瓶在创伤急诊术后的应用效果。方法:选择急诊治疗的皮肤缺损创伤患者60例,都积极给予基于真空负压引流瓶的综合治疗。结果:急诊后患者的感染均得到较好地控制,皮瓣均全部一期成活,且质地外观满意,无严重并发症发生。随着手术时间的推移,患者的创面菌落数呈现明显下降趋势,对比差异有统计学意义(P<0.05)。结论:真空负压引流瓶在创伤急诊术后的应用能降低细菌数量,减少炎性反应,最大限度促进患者的恢复。     

37例普外科伤口感染分析

目的 了解本院普外科伤口感染的相关因素.方法 对我院2002-2伽8年度普外科592例住院手术患者回顾性统计分析.结果 调查的患者中共发生伤口感染37例,感染率为6.25%.结论 高龄、引流管放置、恶性肿瘤、手术相关因素(如急症手术、手术时间长、二,三类手术切口)、术前术中未抗生素预防性使用、循环呼吸系统慢性疾病、耐药菌株感染与伤口感染有明确关系.     

Surgical wound infection in cardiac surgery. A prospective multidisciplinary study

In an attempt to define the incidence of surgical wound complications following open heart surgery, 210 consecutive patients were included in a prospective monocentric study. All were adults with a mean age of 61 years. The different variables incriminated in pathogenesis of surgical wound infections were analyzed in order to evaluate their respective influence. No cases of mediastinitis were noted. The incidence of surgical wound infections was 5.5%. Body mass index > 25 and extensive surgical saphenous dissection in the lower extremities were the only two factors found to show as statistical significance.     

Risk factor and prevention of wound infection after total joint replacement

Objective To analyze the reason of wound infection after total joint replacement and to present the prophylactic management measures. Methods Totally 632 total joint replacements in 587 patients between Jul 2002 and Jun 2005 were retrospectively reviewed. There were 445 cases with total hip replacements and 187 cases with total knee replacements. The specimens for bacterial culture were taken from the hands of the surgical staffs,[第一段]     

颈后路单开门椎板成形术后伤口深部感染的处理

目的探讨颈后路单开门椎板成形术后伤口深部感染及并发化脓性脑脊膜炎的治疗方法。方法分析112例颈后路单开门椎管成形术中,术后发生伤口深部感染4例患者的资料,其中2例因脑脊液漏并发化脓性脑脊膜炎。结果4例患者均彻底清创后一期关闭伤口、置管持续冲洗,2例同时行腰穿蛛网膜下腔置管引流。4例均治愈且神经功能恢复满意。结论颈后路单开门椎板成形术后伤口深部感染是一种严重的并发症,尤其并发脑脊液漏引起化脓性脑脊膜炎,如处理不当会危及生命,一旦发生应引起高度重视。伤口清创持续冲洗,合理的抗生素应用及蛛网膜下腔置管引流等是基本的治疗措施。