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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月至2004年6月广州市儿童医院收治的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。
Objective To understand the distribution of pathogenic bacteria in lower respiratory tract infection in children with congenital heart disease and its influencing factors and to explore effective preventive measures. Methods 483 children undergoing mechanical ventilation after congenital heart disease were admitted to Guangzhou Children’s Hospital from July 2000 to June 2004 for bacterial culture and drug sensitivity test of lower respiratory secretions. Results Twenty-one cases (4.3%) were positive for pathogenic bacteria in lower respiratory secretions, and 35 strains were isolated. After treatment, 20 cases of lower respiratory tract infection were cured, 1 case (3.8%) died of treatment ineffective. The younger, the time of cardiopulmonary bypass and the duration of mechanical ventilation were longer, and the incidence of lower respiratory tract infection was higher in 2 patients with intubation and complication (P <0.01). Conclusions Early postoperative patients with suspected lower respiratory tract infection should be actively carried out etiological examination, the choice of sensitive antibiotics to control infection. Shorten the operation and mechanical ventilation time, the rational use of ventilator, reduce 2 intubation and complications, prevention of lower respiratory tract infection is of great significance.