【摘要】：目的探討老年瓣膜病患者實施心瓣膜置換術(shù)后感染預(yù)防的方法,以降低術(shù)后感染率。方法選取2011年1月-2012年4月醫(yī)院收治的行心瓣膜置換術(shù)老年瓣膜病患者112例,將其隨機分為對照組55例和觀察組57例,對照組圍術(shù)期采用常規(guī)措施進行術(shù)后感染預(yù)防,觀察組圍術(shù)期采用綜合干預(yù)措施預(yù)防術(shù)后感染,比較兩組患者術(shù)后感染率。結(jié)果兩組患者主動脈阻斷時間差異無統(tǒng)計學(xué)意義;觀察組患者機械通氣、麻醉清醒、ICU停留、飲食恢復(fù)及住院時間均明顯短于對照組;兩組患者在手術(shù)開始后腫瘤壞死因子(TNF-α)、白介素-6(IL-6)以及白介素-10(IL-10)血漿含量均明顯升高,至停機1h達高峰,停機24h下降,但仍高于麻醉誘導(dǎo)前;觀察組患者TNF-α、IL-6上述時刻血漿含量明顯高于對照組,IL-10明顯低于對照組;兩組患者于術(shù)后1d和5d時肌酸激酶同工酶(CK-MB)以及cTnT水平均明顯高于麻醉誘導(dǎo)前,且對照組患者明顯高于觀察組;觀察組患者術(shù)后共有1例發(fā)生術(shù)后感染,感染率為1.75%,對照組患者術(shù)后共有4例發(fā)生感染,感染率為7.27%,兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論老年患者行心瓣膜置換術(shù)后機體受到的損傷較大,恢復(fù)也較慢,易發(fā)生術(shù)后感染,因此在圍手術(shù)期給予患者綜合干預(yù)措施,可以降低患者術(shù)后感染率,提升患者恢復(fù)效率,提高手術(shù)治療質(zhì)量。
[Abstract]:Objective to investigate the prevention of postoperative infection in elderly patients with valvular valve replacement and to reduce the postoperative infection rate. Methods 112 patients with valvular valve replacement were randomly divided into control group (55 cases) and observation group (57 cases). The control group was treated with routine measures to prevent postoperative infection during perioperative period. In the observation group, comprehensive intervention was used to prevent postoperative infection, and the infection rate was compared between the two groups. Results there was no significant difference in aortic occlusion time between the two groups, and the observation group was significantly shorter than the control group in terms of mechanical ventilation, awake anesthesia, ICU stay, diet recovery and hospital stay. The plasma levels of tumor necrosis factor (TNF- 偽), interleukin-6 (IL-6) and interleukin-10 (IL-10) were significantly increased in both groups after operation, and reached the peak at 1 hour after operation, and decreased at 24 h after operation. But it was still higher than that before anesthesia induction. The plasma levels of TNF- 偽 and IL-6 in the observation group were significantly higher than those in the control group and IL-10 was significantly lower than that in the control group. The levels of creatine kinase isoenzyme (CK-MB) and creatine kinase (cTnT) were significantly higher in both groups on the 1st and 5th day after operation than before anesthesia induction, and those in the control group were significantly higher than those in the observation group. There was 1 case of postoperative infection in the observation group and 4 cases in the control group. The infection rate was 7.27. The difference between the two groups was statistically significant (P0.05). Conclusion the elderly patients after cardiac valve replacement have more injury, slower recovery and more easily infection after operation. Therefore, comprehensive intervention measures in perioperative period can reduce the postoperative infection rate and improve the recovery efficiency of the patients. Improve the quality of surgical treatment.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院心臟外科;河南南陽醫(yī)專第一附屬醫(yī)院心臟外科;
【基金】：河南省衛(wèi)生廳基金資助項目(HW-2009B-021)
【分類號】：R654.2

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