• 乳腺癌术后皮瓣坏死伴感染的病原菌分布特点及危险因素
  • Analysis on the Distribution Characteristics of Pathogenic Bacteria and Risk Factors in Necrotized Skin Flap Complicated with Infection after Breast Cancer Surgery
  • 刘 鹏.乳腺癌术后皮瓣坏死伴感染的病原菌分布特点及危险因素[J].中国烧伤创疡杂志,2021,(2):131~135.
    DOI:
    中文关键词:  乳腺癌  皮瓣坏死  感染  危险因素  病原菌
    英文关键词:Breast cancer  Skin flap necrosis  Infection  Risk factors  Pathogenic bacteria
    基金项目:
    作者单位
    刘 鹏 安阳市肿瘤医院乳腺外科 
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    中文摘要:
          目的 回顾性分析乳腺癌术后皮瓣坏死伴感染的病原菌分布特点及相关危险因素。方法 选取2018年1月至2020年1月安阳市肿瘤医院收治的100例乳腺癌术后出现皮瓣坏死伴感染及130例未出现皮瓣坏死伴感染的患者作为研究对象,分别将其设为研究组与对照组,统计入组患者的年龄、体重指数、是否合并糖尿病、手术类型、切口类型、是否应用电刀分离、术前是否行放化疗、是否行加压包扎以及合并感染患者的菌株类型,多因素Logistic回归分析皮瓣坏死伴感染的独立危险因素,并总结感染患者病原菌分布特点。结果 100例乳腺癌术后皮瓣坏死伴感染患者创面分泌物中共分离培养出病原菌139株,其中革兰氏阳性菌94株(67.6%),尤以金黄色葡萄球菌(40.3%)、表皮葡萄球菌(13.7%)检出率高;革兰氏阴性菌36株(25.9%),尤以大肠埃希菌(12.9%)、阴沟肠杆菌(6.5%)检出率高;真菌9株(6.5%),多为白色念珠菌(4.3%)。单因素分析结果显示,研究组患者年龄、体重指数明显高于对照组(t=4.635、5.356,P均<0.001),合并糖尿病、术前放化疗及加压包扎患者人数明显多于对照组(t=6.316、4.910、14.206,P=0.012、P=0.027、P=<0.001),而手术类型、切口类型、电刀应用情况无明显差异(t=0.009、0.048、0.146,P=0.922、0.827、0.702);多因素Logistic回归分析结果显示,年龄、合并糖尿病、术前放化疗是乳腺癌术后皮瓣坏死伴感染的独立危险因素(95% CI:1.794~12.152、1.916~58.735、1.279~6.875,P=0.002、0.007、0.011)。结论 导致乳腺癌术后皮瓣坏死伴感染的病原菌以革兰氏阳性菌中的金黄色葡萄球菌及表皮葡萄球菌、革兰氏阴性菌中的大肠埃希菌及阴沟肠杆菌、真菌中的白色念珠菌为主,且年龄、合并糖尿病、术前放化疗是其独立危险因素。
    英文摘要:
          【Abstract】Objective To retrospectively analyze the distribution characteristics of pathogenic bacteria and related risk factors in necrotized skin flap complicated with infection after breast cancer surgery. Methods One-hundred patients with skin flap necrosis combined with infection and 130 patients without skin flap necrosis and infection after breast cancer surgery,admitted to Anyang Tumor Hospital from January 2018 to January 2020,were selected as the research subjects to be set respectively as a study group and a control group. Such factors as age,body mass index,with diabetes or not,the type of surgery,incision type,application of electrotome or not,with radiotherapy and chemotherapy before operation or not,with pressure dressing or not,and the strain type of patients with infection,were recorded,multivariate Logistic regression analysis was conducted to analyze the independent risk factors for skin flap necrosis combined with infection,and distribution characteristics of pathogenic bacteria in infected patients were summarized. Results 139 strains of pathogenic bacteria were isolated from the wound secretions of the 100 patients with skin flap necrosis and infection after breast cancer surgery. Among them,there were 94 strains of gram-positive bacteria (67.6%),with high detection rates in staphylococcus aureus (40.3%) and staphylococcus epidermidis (13.7%),36 strains of gram-negative bacteria (25.9%) with high detection rates in escherichia coli (12.9%) and enterobacter cloacae (6.5%),9 strains of fungus (6.5%),mostly being Candida albicans (4.3%). The results of single factor analysis showed that the age and body mass index of patients in the study group were significantly higher than that in the control group (t=4.635,5.356,all P<0.001),and the number of patients with diabetes,number of patients who underwent radiotherapy and chemotherapy before operation,and number of patients received pressure dressing in the study group were significantly more than that in the control group (t=6.316,4.910,14.206,P=0.012,P=0.027,P=<0.001). However,no significant statistical differences were observed between the two groups in terms of the type of surgery,incision type,and application of electrotome (t=0.009,0.048,0.146,P=0.922,0.827,0.702). Multivariate Logistic regression analysis showed that age,combined with diabetes,and preoperative radiotherapy and chemotherapy were the independent risk factors for skin flap necrosis and infection after breast cancer surgery (95% CI: 1.794-12.152,1.916-58.735,1.279-6.875,P=0.002,0.007,0.011). Conclusion Staphylococcus aureus and staphylococcus epidermidis (gram-positive bacteria),escherichia coli and enterobacter cloacae (gram-negative bacteria) and candida albicans (fungus) are the main pathogens leading to postoperative skin flap necrosis and infection after breast cancer surgery. Age,combined with diabetes,and preoperative radiotherapy and chemotherapy are the independent risk factors for such necrosis and infection.