口腔颌面肿瘤术后感染的原因分析与预防

目的探讨口腔颌面肿瘤术后感染的病原菌种类及防治措施。方法对口腔颌面肿瘤术后引起感染的原因、病原菌种类及耐药性进行调查分析。结果口腔颌面肿瘤术后感染率为12.60%(81/643);感染的发生与年龄、侵入性操作、制动和误吸等有关;创口和下呼吸道是感染发生的主要部位;感染病原菌以葡萄球菌为主(占46.88%),其次为链球菌(占11.72%)、大肠杆菌(11.72%)和铜绿假单胞菌(10.94%),真菌的感染率为6.25%;耐苯唑西林葡萄球菌检出率为66.3%,耐苯唑西林葡萄球菌对七种常用抗菌素耐药率均在50%以上;革兰阴性杆菌对4种及4种以上的抗生素的耐药率超过40%,其对大多数常用抗菌素均显示较高的耐药率(>55%),与非耐药株有统计学差异。结论口腔颌面肿瘤术后感染以革兰阳性菌感染为主,但革兰阴性菌仍是重要的致病菌;抗生素耐药率逐渐升高,且具有高耐药与多重耐药的特点。预防性应用抗生素可明显减少术后感染的可能性,治疗时建立有效的引流是必不可少的方法,细致而熟练的护理也是避免术后感染发生的重要措施。

Analysis of Infections After Tumor Surgery of Oral and Maxillofacial Region and its Prevention and Cure

Objective To discuss the pathogenic species of infection after tumor surgery of oral and maxillofacial region and to explore the prevention and cure countermeasures.Methods The risk factors,pathogenic species and drug resistance of infections after oral and maxillofacial region tumor surgery were studied. Results The infection rate was 12.60%(81/643) after surgical removal of tumors in the oral and maxillofacial region.The infections were related to patient's age,invasive procedures,immobilization and aspiration.The main infected sites were the surgical wound and the lower respiratory tract.The leading pathogen was Staphyloccus(46.88%),and followed by Streptococcus(11.72%),Escherichia coli(11.72%) and Pseudomonas aeruginosa(10.94%).The fungal infection rate was 6.25%;Amoxacillin resistance staphylococcus was 66.3%,which resisted 7 antibiotics and the rate was over 50%.The Gram negative bacilli resisted 4 or more antibiotics,and the resistance rate was over 40%,there were relatively high resistance rates(>55%)against most of antibiotics.There showed statistical difference between the resistant strains and the non-resistant strains. Conclusions Though Gram negative bacilli play an important role,most infections are still caused by Gram positive coccus after tumor surgrey in the oral and maxillofacial region.The antibiotics resistance rate of all bacteria pathogens rises gradually,and shows strong and multiple drug resistance. Preventive antibiotics significantly reduce the postoperative infection, and moreover,careful and skilled nursing is also the important countermeasure.