先天性心脏病术后下呼吸道感染监测和预防.docVIP

先天性心脏病术后下呼吸道感染监测与预防 陈兆鸿，谢永强，张志意 【摘要】 目的 了解先天性心脏病患儿手术后下呼吸道感染的病原菌分布及其影响因素，探讨有效的预防措施。方法 对2000年7月～2004年6月收治的483例先天性心脏病术后机械通气的患儿进行下呼吸道分泌物细菌培养和药物敏感试验。结果 21例（4.3％）下呼吸道分泌物培养致病菌阳性，共分离出35株细菌。经治疗后20例下呼吸道感染治愈，1例（3.8％）治疗无效死亡。年龄小、体外循环时间及机械通气时间长、2次插管及发生并发症者下呼吸道感染率较高（P＜0.01）。结论 术后早期对疑有下呼吸道感染者，应积极进行病原学检查，选择敏感的抗生素控制感染。缩短手术和机械通气时间、合理使用呼吸机、减少2次插管和并发症，对预防下呼吸道感染有重要的意义。 【关键词】先天性心脏病；心脏直视手术；机械通气；下呼吸道感染 Monitor and prevention of postoperative lower respiratory tract infection after open heart surgery in patients with congenital heart malformations Chen Zhaohong, Xie Yongqiang,Zhang Zhiyi .Guangzhou Children’s Hospital, Guangzhou 510120，China Abstract Objective To investigate the category of germ and the concerned factors induced postoperative lower respiratory tract infection after open heart surgery in patients with congenital heart malformations and to explore the prevention measures Methods The germ cultures of secretion specimens obtained from lower respiratory tract and drug sensitive test were conducted in 483 patients during mechanical ventilation after open heart surgery from July 2000 to June 2004. Results 35 germ strains were isolated in 21 patients (4.3%). 20 patients were cured, and one died(3.8%). The incidence of lower respiratory tract infection was higher in patients who were low patient age, longer extracorporal circulation time and mechanical ventilation duration, twice intubations and complicated (P＜0.01). Conclusion Etiology diagnosis and specific antibiotics were indicated when the patients were suspected of lower respiratory tract infection after open heart surgery. The measures such as shortening extracorporal circulation time and mechanical ventilation duration, performing mechanical ventilation appropriately, reducing twice intubations and complications are important in prophylaxis of lower respiratory tract infection. Keywords Congenital heart malformation; Open heart surgery; Mechanical ventilation; Lower respiratory tract infection 　　先天性心脏病手术后机械通气期