| 徐 岚,郭阳阳,何宗美,查小明,周文斌.改良乳腺癌根治术后切口感染的病原学特征、影响因素及其凝血纤溶功能研究[J].,2021,(17):3247-3251 |
| 改良乳腺癌根治术后切口感染的病原学特征、影响因素及其凝血纤溶功能研究 |
| Study on the Etiological Characteristics, Influencing Factors, Coagulation and Fibrinolytic Function of Incision Infection after Modified Radical Mastectomy |
| 投稿时间：2021-01-05 修订日期：2021-01-28 |
| DOI：10.13241/j.cnki.pmb.2021.17.010 |
| 中文关键词: 乳腺癌 改良乳腺癌根治术 切口感染 病原学特征 影响因素 凝血纤溶功能 |
| 英文关键词: Breast cancer Modified radical mastectomy Incision infection Etiological characteristics Influencing factors Coagulation and fibrinolysis function |
| 基金项目:国家自然科学基金青年基金项目（81502299） |
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| 中文摘要: |
| 摘要 目的：探讨改良乳腺癌根治术后切口感染的病原学特征、影响因素及其对凝血纤溶功能的影响。方法：选取我院于2016年6月~2020年9月期间收治的390例行改良乳腺癌根治术的乳腺癌患者，分析改良乳腺癌根治术后切口感染的病原学特征、影响因素及术后切口感染对凝血纤溶功能的影响。结果：390例行改良乳腺癌根治术的乳腺癌患者，术后发生切口感染28例，术后切口感染率为7.18%（28/390），将未发生术后切口感染的患者纳为未感染组（n=362），发生的纳为感染组（n=28）。28例发生感染的患者共分离培养病原菌36株，其中革兰阳性菌14株，占比38.89%（14/36），以金黄色葡萄球菌、粪肠球菌为主。革兰阴性菌21株，占比58.33%（21/36），以大肠埃希菌、铜绿假单胞菌为主。改良根治术后乳腺癌患者切口感染的影响因素包括手术时间、术后住院时间、合并基础疾病、引流时间、年龄、白蛋白（P<0.05）。多因素Logistic回归分析发现：合并基础疾病、年龄≥60岁、白蛋白＜35 g/L、手术时间≥120 min均是改良乳腺癌根治术后切口感染的影响因素（P＜0.05）。两组术后30 d凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）升高，且未感染组高于感染组（P<0.05），纤维蛋白原（FIB）降低，且未感染组低于感染组（P<0.05）。结论：改良乳腺癌根治术后切口感染较为常见，致病菌以革兰阴性菌为主，年龄、合并基础疾病、白蛋白、手术时间均是其影响因素，同时术后切口感染的发生可影响凝血纤溶功能的恢复，临床医生应积极采取措施预防术后切口感染的发生，从而保证手术治疗效果。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the etiological characteristics, influencing factors, coagulation and fibrinolytic function of incision infection after modified radical mastectomy. Methods: 390 patients with breast cancer undergoing modified radical mastectomy in our hospital from June 2016 to September 2020 were selected. The etiological characteristics and influencing factors of incision infection in patients with breast cancer after modified radical mastectomy and the influence of incision infection on coagulation and fibrinolysis function were analyzed. Results: In 390 patients with breast cancer undergoing modified radical mastectomy, 28 patients had postoperative incision infection, and the incision infection rate was 7.18%(28/390). The patients without incision infection were included in the non infection group(n=362), and the patients with incision infection were included in the infection group (n=28). A total of 36 pathogens were isolated from 28 patients with incision infection after radical mastectomy. Among them, 14 strains were Gram-positive bacteria, accounting for 38.89% (14/36). Staphylococcus aureus and Enterococcus faecalis were the main pathogens. 21 strains of Gram-negative bacteria, accounting for 58.33%(21/36), were mainly Escherichia coli and Pseudomonas aeruginosa. The influencing factors of incision infection in breast cancer patients after modified radical mastectomy included operation time, postoperative hospital stay, underlying diseases, drainage time, age and albumin(P<0.05). Multivariate logistic regression analysis showed that combined with basic diseases, age ≥60 years old, albumin < 35 g/L, operation time ≥120 min were the influencing factors of incision infection after radical mastectomy(P< 0.05). The prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) increased at 30 days after operation in the two groups, and the infection group was higher than the infection group (P<0.05), and the fibrinogen (FIB) was decreased, and the infection group was lower than the infection group (P<0.05). Conclusion: Incision infection after modified radical mastectomy is relatively common. Gram-negative bacteria are the main pathogenic bacteria. Age, combined basic diseases, albumin and operation time are the influencing factors. At the same time, the occurrence of postoperative incision infection can affect the recovery of coagulation and fibrinolysis function. Clinical doctors should actively take measures to prevent the occurrence of postoperative incision infection, so as to ensure the effect of surgical treatment. |
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